NH adults on Medicaid need more dentists, especially adults with disabilities

If there was any question about whether adults with Medicaid in New Hampshire would take advantage of having preventative dental care for the first time, consider this: In the program’s first eight months, more than 8,000 people have seen a dentist, oral surgeon, or hygienist.

Two other numbers are shaping the program’s goals. Only about 145 of the state’s 850 dentists are participating. And a much smaller fraction are seeing patients with disabilities.

With nearly 95,000 adults on Medicaid as of October, more than 15,000 of them with disabilities, both numbers need to grow, said officials heading up the New Hampshire Smiles program.

The state Department of Health and Human Services and Northeast Delta Dental, which has a $33.5 million contract to manage the program, and DentaQuest, which is handling the administrative pieces, are meeting at least weekly to identify and respond to challenges. A particular focus in the first several months has been recruiting oral surgeons given that patients who’ve not had dental care for years are more likely to have acute dental disease or other problems.

ABLE NH, a statewide disability justice organization, has joined that recruitment effort with a particular audience in mind.

“We really want the message to be clear that oral health care is for everyone, including people with disabilities,” Executive Director Sarah Tollefsen said Wednesday at the New Hampshire Oral Health Coalition’s annual conference.

In an interview Thursday, she said the goal will be recruiting more dentists, oral surgeons, and hygienists to treat people with disabilities by helping providers feel more confident in delivering that care. “We’re stopped by our fears,” Tollefsen said.

That effort will include developing an oral health care guide for providers on how to care for people with disabilities. The group is developing a toolkit for patients to help them advocate for the dental care they need, especially for those who’ve not seen a dentist in years or ever.

If ABLE NH secures grant funding, it will also hire a liaison who will travel the state, meeting with providers who are interested in taking on special needs adult Medicaid patients but are hesitant.

“I’m hoping that the dental liaison will build relationships with those dental offices,” Tollefsen said, “and those offices will feel comfortable calling and saying, ‘Listen we have this person coming in and here are my concerns and fears and worries. Can you give us a little bit of technical support?’”

While providers may need specific guidance, such as how to transfer a patient from a wheelchair to the dental chair, Tollefsen said the first step should be asking patients how they’d like their care delivered. Would they prefer to be treated in their wheelchair? Would they like a family member or friend to be with them? How do they prefer to communicate their concerns and questions?

It’s not unlike the way dental offices have responded to any patient’s anxiety by offering them headphones so they can listen to music during a procedure. “It’s really all practical stuff,” Tollefsen said.

Meanwhile, the state Department of Health and Human Services, Northeast Delta Dental, and DentaQuest are supporting ABLE NH’s efforts and pursuing their own. They are mindful that even with 147 providers in the program, adults with Medicaid are waiting months for an appointment, though they note that the shortage of hygienists and other oral health care providers means even those with commercial insurance are waiting months, too.

Tom Raffio, president and CEO of Northeast Delta Dental, said that to meet patients’ needs, the program must add 200 providers.

Aware that low Medicaid reimbursement rates are a barrier, he has worked with the state to increase Medicaid reimbursement rates for some procedures. His company has started a student loan repayment program for newer dentists who sign on. They’ve recruited Solvere Health to offer mobile dental clinics all over the state, with a particular focus on the North Country, where there are fewer providers in the program.

Raffio is traveling the state, having one-on-one conversations with providers, answering their questions. Dr. Sarah Finne, dental director at the Department of Health and Human Services, is meeting weekly, sometimes daily, with Raffio’s team and DentaQuest. They said providers are signing on because a peer has told them they’ve had a good experience.

At the same time, they are trying to increase the number of patients by contacting adult Medicaid recipients, one at a time. If a patient cancels or misses an appointment, DentaQuest follows up to find out why and help them to reschedule. DentaQuest can also arrange transportation to and from an appointment.

“We realize we need to get that information from the people who are out there on the ground,” Finne said, “and use that information to help guide us, as we tweak the programs so that we’re really serving everybody that we need to serve.”

Gail Brown, director of the New Hampshire Oral Health Coalition, helped lobby lawmakers for years before they agreed last year to expand dental benefits to adults with Medicaid. She said she’s impressed to see that 8,000 patients have been served and that 147 providers have joined since the program launched in April. There were just 78 providers at the start.

“Right now, we’re not where we want with the number of providers,” Brown said. “But I talked with someone from (another) state and they were at like half of the engagement we were and had been operating longer. I’m amazed at what we were able to do.”

Finne said early success is not enough.

“We’re not done just because it’s up and running,” she said. “We’re not going to sit back and say, ‘Okay, let’s just let it go.’ We are knee-deep in trying to make sure that we achieve what we set out to.”

The Department of Health and Human Services is providing additional information about the program via phone at 844-583-6151 and, for those who need assistance hearing and speaking, at 800-466-7566. There is also information on its website, at dhhs.nh.gov. Enter “smile program” in the search bar.

This story was originally published by the New Hampshire Bulletin

This article originally appeared on Portsmouth Herald: NH adults on Medicaid need more dentists