Forum Communications: Poor Minnesotans and dentists struggle to smile

ST. PAUL—Many low-income Minnesotans cannot afford to go to a dentist and many dentists say they cannot afford to serve those who receive state assistance.

For serving the poor, Minnesota pays dentists 27 percent of what other Minnesotans pay. Because of that, many dentists no longer accept patients on Medicaid, a federal-state medical coverage program for the poor known in Minnesota as Medical Assistance. Other dentists limit how many MA patients they serve.

Baxter, Minn., dentist Dr. Kevin Dens says on Thursday, March 2, 2017, that while poor Minnesotans have little dental access, it is worse in rural Minnesota. Don Davis / Forum News Service

“Many dental clinics, and especially small clinics in the rural parts of the state, cannot afford to serve those patients,” Baxter Dentist Dr. Kevin Dens said Thursday, March 3, as the Minnesota Dental Association lobbied lawmakers to increase spending on dental programs up to $120 million in the next two years.

Minnesota’s Medical Assistance reimbursement rate for dentists is the worst in the country for children and fourth worst for adults.

“We are failing our children and we are not doing much better for our adults,” said Dens, who is president of the dental group.

The situation is worse in greater Minnesota, where dentists overall are in short supply. Dentists say the low state payments means they cannot afford to keep workers, which affects all patients.

Minnesota taxpayers are affected, Dr. Mary Seieroe of Hennepin County Medical Center said, because thousands of people go to emergency rooms when dental issues get out of control. ERs are not equipped to cure the problem, just to treat symptoms, such as giving patients narcotics or antibiotics.

Most dental problems that send people to the ER could have been avoided with regular dental care, she said.

Greater Minnesota residents are especially affected, with just one dentist per 10,000 people in some areas.

Dens said a Detroit Lakes woman recently drove 89 miles to his office because she could find no dentist at home who would accept MA.

Stephanie Hogenson, research and policy director for Children’s Defense Fund-Minnesota, explained that, even if families on Medical Assistance do manage to make an appointment, they can find themselves face to face with other hurdles.

“Actually getting to an appointment is difficult and can be costly, if they have to take time off of work, for example,” she said.

Hogenson said that families can be asked to travel hours for a simple dental appointment.

“Rural areas have some pretty acute problems,” said Dr. Michael Helgeson of Apple Tree Dental.

One county has no dentist and some have just one.

In Lewiston, in southeastern Minnesota, Dr. Michael Flynn is worried about the future.

“I am going to be 64 in two weeks,” said Flynn, adding that half of his patients are on Medical Assistance. “Unless there is a change, there will not be a replacement for Dr. Flynn in Lewiston.”

Young dentists may face repaying school loans of $250,000. Dens said they often cannot earn enough in rural areas, so opt for places like the Twin Cities.

“If you are a young dentist by yourself, and have to pay your bills, you always are going to take a private-pay patient who can pay you…” Dens said. “It is a business.”

Helgeson said that “we have reached a crisis point,” with small state payments resulting in employees leaving Minnesota dentists.

In northwestern Minnesota, Helgeson said, some go to North Dakota, which pays dentists twice to care for the poor as much as Minnesota.

Nearly 1,200 people are on a waiting list to get a dentist in northwestern Minnesota alone, Helgeson said.

Many end up in ERs, he said. “It is not something that can be sustained.”

ER visits by people on state assistance may cost taxpayers $50 million annually, dentists said.