Even though New Hampshire’s Medicaid expansion covering preventative dental care for adults doesn’t take effect until April, Dr. Steve Hoffman said Dental Health Works in Keene has already been getting calls about it.
The nonprofit is one of the few dental offices in the Elm City that accepts Medicaid, and its leaders have been discussing how to approach the expansion and the new demand expected to come with it. But Hoffman said implementing the program will be challenging unless more local dentists get involved.
“I think we’re going to have quite a number of people calling,” Hoffman said. “In terms of our preparation, we’re thinking about it and we’re trying to decide how we will handle it, but it’s going to be very difficult unless we get other community offices to participate. We won’t be able to treat everyone.”
Currently, New Hampshire’s Medicaid program only covers dental care for children, not adults. But starting in the spring, adult Medicaid recipients will be able to use the new benefit for preventative care services such as cleanings, examinations and fillings.
To qualify for Medicaid in New Hampshire, a single person must be earning less than $18,075 per year, $24,353 for a two-person household.
Hoffman, who also serves on the N.H. Dental Society’s Medicaid Advisory Committee, said Dental Health Works has between 4,000 and 5,000 patients, and 30 to 40 percent of them are Medicaid recipients.
The state expects the program to be popular, too, with the N.H. Department of Health and Human Services anticipating that some 88,000 people will take advantage of it, according to Dr. Sarah Finne, Medicaid Dental Director with the state health department. However, she noted the state is aware of the shortage of dentists who accept Medicaid and has made efforts to address some of the reasons why so many providers have chosen to opt out.
“This is a concern for any Medicaid program across the country, it is not limited to NH,” Finne told The Sentinel in an email. “DHHS has done its best to engage dentists throughout the development of the benefit through the Adult Dental Benefit Work Group that met for the last few years.”
That work group has identified three major barriers: low reimbursement rates, issues related to transportation for appointments and a lack of care management, which has been exacerbated by staffing shortages. Finne said these were considered in the development of the new benefit in an effort to incentivize more dentists to join the state’s Medicaid network.
In the case of the low reimbursement rates, seen as one of the biggest barriers for accepting Medicaid, Finne said the state is raising the rates to be on par with the national average.
As of 2020, New Hampshire’s Medicaid reimbursement rate for child dental services was 52.4 percent of private insurance reimbursement, compared to a national average of 61.4 percent, according to the American Dental Association and the Health Policy Institute. The national average Medicaid reimbursement rate for adult dental services was 53.3 percent.
“We realized it was a very important factor in building an adequate network of dental providers,” she said.
Hoffman agreed that the reimbursement issue was a significant problem, and said being a nonprofit doesn’t make it any easier financially for Dental Health Works to accept Medicaid.
Increasing accessibility to dental care is part of Dental Health Works’ stated mission and that’s why the organization accepts Medicaid, he explained, but private dental practices are often simply unable to afford it.
“Typically, Medicaid reimbursement rates are quite low, and in New Hampshire for sure, it’s somewhere below 50 percent…,” Hoffman said. “If you look at that from a business standpoint, it’s hard to pay your bills.”
Dr. Thomas Filip of Keene’s Noble Dental said only about 16 percent of dentists in New Hampshire accept Medicaid, and his practice is not among them.
Filip, who said he is also a board member at Dental Health Works, agreed that reimbursement rates, along with administrative difficulties and issues with patients being able to keep appointments, are among the reasons why accepting Medicaid hasn’t been feasible for him in the past.
But with changes on the horizon that may make it easier for dentists to participate in the program, Filip said the option might now be on the table. Everything depends on how the details are ironed out over the next few months, he added.
“The reimbursement schedule is not yet available,” Filip said. “And the administrator of that has not been decided yet. So we don’t know who will administer the benefits, whether that’s Delta Dental or some other company.”
Filip said he was hopeful Delta Dental, a dental insurance company that works with dental health providers nationwide, would win the bid. He said the firm has a strong track record with the benefits it offers and could leverage its existing network of providers to encourage others to participate.
With a lot of decisions still to be made at the state level, both Filip and Hoffman say they’re waiting to see what happens before deciding exactly how they’re going to respond to Medicaid’s new adult dental benefit.
Hoffman said another challenge with accommodating the Medicaid expansion is that Keene can be a difficult area to recruit health care providers, given how far it is from major population centers. Filip noted that several practices in the Keene area are understaffed.
Despite any difficulties, both dentists said the new benefit is something that has long been needed and will be much appreciated by people in the community who rely on Medicaid for their health care needs.
Filip said New Hampshire has fallen behind other states that already offer preventative dental care through their Medicaid programs and said he hopes the state’s dental benefit becomes even more comprehensive in the future.
“Just offering preventive services is great and hopefully they’ll provide other services,” he said. “These are usually very bare bones plans available to many people who have great need, so often there’s a mis-match. But anything helps.”
New Hampshire is one of just nine states that only offer emergency services, like extractions, to adult Medicaid recipients. While dental services for children are required by the federal government, adult dental services are optional and only covered in 35 states.
Hoffman said Medicaid coverage for preventative dental care is something the N.H. Dental Society, New Hampshire’s professional association for dentists and other oral health specialists, has been advocating for many years.
He added that Dental Health Works is one of three N.H. dental offices participating in a residency program focused on bringing dentists to more rural parts of New Hampshire. He added that he hopes Medicaid’s new adult dental benefit will be in place by the time they arrive.
“In my years of practice, we’ve talked about this forever,” he said. “So it’s a really great thing that it’s finally culminating, it’s happening.”