This story was originally published by Flatwater Free Press.
Arline Morris’ teeth are failing fast. She can’t eat much, and struggles with constant pain while taking medication that makes her teeth even more fragile.
She’s been offered appointments at Lincoln and Omaha dental clinics that will accept her Medicaid insurance. But Arline lives in Stratton, in southwest Nebraska – more than 200 miles from the nearest dentist who will take her.
It’s an eight hour round trip, plus hours of dental work, and that’s all but impossible. A long car ride can leave Arline suffering in bed for days. Medicaid doesn’t cover an overnight stay.
John Morris, Arline’s husband, spends his days phoning for help. He’s talked to more than 50 dentists’ offices, with no luck.
“Either you hurt with your teeth, or you hurt for several days in your bed and you can’t move or eat,” John Morris said.
Each year, fewer dentists can afford to treat Nebraska’s Medicaid patients. In the past five years, the number of dental providers treating Medicaid-eligible patients nosedived 37%.
The problem is severe in western Nebraska. Only two dozen dentists west of Kearney have been paid for treating a Medicaid patient this year.
Forty-three Nebraska counties, many in the state’s western half, have zero dentists helping low-income Nebraskans like Arline Morris.
Within a 90-mile radius of the Morris’ home, only three dentists’ offices accept new Medicaid patients. One is a pediatric practice. The other two are separate small offices for one dentist.
Arline needs major work that her last dentist couldn’t do in her satellite office in Paxton.
That dentist has since stopped taking new Medicaid patients, John Morris said, because the office was “overwhelmed” with a 100-patient waitlist.
Then, on August 1, the Paxton office closed, leaving the Medicaid patients of western Nebraska with one fewer option.
In 2017, nearly 600 dental providers treated at least one Nebraska Medicaid patient, according to reimbursement records from Nebraska’s Department of Health and Human Services.
By 2022, that number had fallen to 378.
Why? Because it doesn’t pay.
State government reimbursements have fallen “far below market levels,” said Dr. Jessica Meeske. They fail to cover the costs of most dental procedures, leading to what Meeske calls a “crisis level” of patients who can’t get care.
Meeske, a Hastings pediatric dentist, said her clinic turns away 15 families a day because they are “overloaded and booked out.” The pediatric dentists at a North Platte office are in the same quandary.
“We’re hearing multiple reports that patient families from western Nebraska are having to go all the way to Lincoln for dental care,” Meeske said.
Five or six urgent calls per day come to Kim Danehey-Nibbe at Central Community College’s dental hygiene program. Medicaid patients are phoning, often in serious pain.
Central Community College is one of only three providers accepting new Medicaid patients in Hastings.
“A lot of the comments I’ll get is, you’re probably the 40th place I’ve called, and nobody’s taking,” said Danehey-Nibbe.
Nebraska’s Medicaid program picked up the tab for 39% of the average cost of dental work in 2021, according to a Nebraska Dental Association survey. That’s far below private insurance and lower than some neighboring states’ Medicaid programs.
Rising costs and more patients due to Medicaid expansion have made it tougher for dentists to manage the financial hit, Meeske said.
“Grocery stores don’t sell food for 40% of their price to SNAP customers. Why is health care partially financed by the professionals providing the service?” said David O’Doherty, director of the Nebraska Dental Association, in an email.
Nebraska’s Medicaid program, run by DHHS, sets its rates inside the budget allocated by the Nebraska Legislature.
“As a public service, funded by the state, those rates are limited by the appropriation from the legislature,” said Collin Spilinek, a DHHS spokesperson. “As a result, there is only so much that Medicaid can do to address this concern directly.”
The Legislature has made some attempts to improve the situation, and did boost Medicaid reimbursement rates by 3% this year – though that bump was far smaller than is needed, dentists say.
Gov. Jim Pillen line-item vetoed the rate increase in the two-year budget, holding it stagnant for 2024.
Meanwhile, John Morris keeps an eye on Facebook posts about dentists. People are constantly asking if anyone knows an office accepting new Medicaid patients near North Platte or McCook. There are rarely answers.
“People can’t stay in business if they’re losing money every time they make a transaction,” he said.
Alison McAleese-Reents went to sleep on December 23, 2020, with her jaw hurting. By morning, the side of her face had swelled like a balloon.
She went to Hastings Convenient Care. The nurse sent her straight to the hospital.
“My friend sent me in with her phone number pinned to my shirt because I was pretty out of it,” McAleese-Reents said. “I didn’t realize how bad it was.”
She was immediately wheeled into emergency surgery at Hastings’ Mary Lanning hospital. An infection had spread from one bad tooth into her jawbone. Her surgeon acted quickly.
When she awoke on Christmas Eve, all 32 teeth were gone. Her mouth was empty, her life altered.
“I can’t even tell you what that was like to wake up to. … I start feeling around my mouth like ‘whoa, whoa, what’s this about?’” McAleese-Reents said. “I thought they got the wrong patient at first.”
McAleese-Reents has long lacked adequate dental care, she said, because options for Medicaid patients are limited near Hastings. Before she qualified for Medicaid, McAleese-Reents couldn’t afford dental insurance.
“You can’t afford to go, and then when you qualify for Medicaid, there’s nowhere to go,” she said.
Patients who can’t get regular dental care often rush to emergency rooms when pain becomes severe. Some 79% of those visits should happen at a dental office, said Kelsey Arends, a Nebraska Appleseed health care attorney.
Preventative, consistent dental care costs far less than ER treatment, Arends said – making it less burdensome on taxpayers. In-office care has other benefits, she said. One: Fewer opioid prescriptions.
When McAleese-Reents awoke with no teeth on Christmas Eve, she immediately worried about what was next.
“How am I going to pay for dentures?” she said.
Nebraska’s Medicaid adult dental benefits are capped at $750 per year. McAleese-Reents worried she wouldn’t have anything left for other dental care.
Her hospital care team contacted Smile Dental Group, who donated high-quality dentures and fitting appointments.
“The dentures usually for Medicaid are cheaper and they’re very thick,” McAleese-Reents said. “When I look at mine, I’m just blown away.”
In January, the annual $750 benefits cap will be lifted, alongside other changes to Medicaid dental coverage.
“We feel that this change will allow our members to receive needed care in a timely fashion and will allow appropriate compensation to the dentists …” Spilinek said in an email.
Nebraska Medicaid is also changing reimbursements to better pay dentists for dentures and wisdom teeth. Providers are optimistic the changes will help more Nebraskans get care.
When open enrollment begins in November, patients will have a choice between three plans, each including dental work.
Patients hope the new setup makes it easier to find dentists and cuts down their pointless phone calls.
The repeated calls are wearing on John Morris. Repeatedly asking for help is frustrating, he said. Embarrassing.
Recently, Morris called DHHS while sitting with his wife in their home 200 miles from Lincoln. He said the employee who answered repeatedly yawned into the phone.
“Everybody wants to feel like they’re the only person that matters when somebody’s talking to them, but obviously that just isn’t possible,” Morris said. “It’s just hard. You don’t know where to turn, it’s hard to get answers.”
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