It’s no secret that there is an oral health care access gap for North Carolinians with Medicaid insurance. It’s practically a rule of thumb that if you are born poor, you will have less access to health care services (medical and dental), and in turn will likely end up with greater incidence of dental disease.
There are many reasons why this is true. From the food on your table (click here to learn more about how where you live can impact access to healthy food) to the transportation you can access, the distance between your home and the nearest oral health care facility, and more, social determinants of health can significantly impact access to care.
In fact, an estimated 80 percent of a person’s health is the result of factors outside of a medical office.
That isn’t to say that the oral health care system itself is an insignificant factor. For a variety of reasons, there simply are not enough providers who accept Medicaid insurance, which creates large areas where adults and children alike cannot access the care they need and deserve.
North Carolina Medicaid Oral Health “Secret Shopper” Survey
The NCOHC team recently conducted an internal secret shopper survey in Western North Carolina, a region with significant oral health care access issues for Medicaid-insured individuals. Over the course of several weeks, NCOHC staff contacted oral health care providers listed on the website Insure Kids Now to inquire about an appointment for a seven-year-old child with Medicaid insurance.
Of 119 WNC locations, 50 were listed as accepting children with Medicaid insurance. Fifty-seven were listed as not accepting Medicaid, and 12 did not indicate whether or not they accept Medicaid. Upon calling each location, NCOHC found that only 35 locations were currently accepting Medicaid-insured children. A total of 70 did not accept Medicaid, and NCOHC staff were unable to reach the remaining 14 locations. Three counties were found to not have a single Medicaid-accepting oral health care provider.
Note: The NCOHC survey was conducted to serve as a preliminary look at the oral health care landscape in Western North Carolina, an area with significant access concerns. And while it was not conducted as a comprehensive research project, NCOHC’s findings do reflect some of the access gaps identified in the recent American Dental Association Health Policy Institute’s report on Medicaid access in North Carolina. Particularly, maps in the report of meaningful pediatric Medicaid dental office locations starkly visualize the relative scarcity of providers in the western part of the state compared to North Carolina’s urban centers.
Increasing Medicaid Acceptance by Oral Health Providers in North Carolina: What Can We Do?
It’s important to ask why these access gaps occur. Even when there are dental providers in an area, why do so many not accept Medicaid insurance?
Addressing Payment Disparities
Medicaid reimbursement rates for oral health care tend to be lower than the rates private insurers pay, often falling below the actual cost of performing some procedures. For many private practices, this can pose a significant financial issue.
Possible paths forward include increasing reimbursement rates to a level where Medicaid is on par with private insurers and simplifying the filing and appeals processes.
Strengthening the Oral Health Care Safety-Net
Another option is to patch up the holes in our “safety-net” facilities. Across North Carolina, Federally Qualified Health Centers (FQHCs), local health departments, and other safety-net facilities care for large numbers of our state’s residents who have Medicaid insurance or are uninsured or underinsured.
FQHCs, for example, receive federal funding that helps reduce the financial gap between Medicaid reimbursement rates and private insurance rates (as well as the gap between patients with insurance and those who can’t pay at all). Despite this support, many FQHCs still struggle to cover their costs. Additional funding will be needed to ensure the sustainability of these organizations’ efforts.
Similarly, local health departments and other safety-net facilities often receive funding from the government, charitable organizations, and private donors that help them see any patient, regardless of their ability to pay.
Systems-Level Reform to Address Medicaid Oral Health Care Access in North Carolina
To solve the Medicaid access gap issue, we must ask the right questions — and address the systemic challenges driving these disparities. For example:
- What policies or other initiatives could strengthen the safety-net environment, allowing facilities like FQHCs to expand into regions that are underserved?
- Can we achieve policy reform to increase reimbursement rates?
- If so, how long will that take, and what can we do to help those in need in the meantime?
The solution to North Carolina’s Medicaid oral health care access issues will likely require organizing to build support for changes to the Medicaid system while also driving policy change to better support the safety net. No less important, however, and as NCOHC always emphasizes, we are far more likely to solve the problem through collaboration.
Doing nothing simply isn’t an option.
NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.
