Dental care for low-income rural residents often out of reach

Dr. Jessica Meeske of Hastings, Neb., works on a patient.
(Photo by Laura Beahm, Flatwater Free Press)

Toothaches can cause a lot of pain and make eating difficult, so it's important to see a dentist as soon as possible. But what if no dentist in your area will accept you as a patient--even if you have state Medicaid insurance? You suffer and search for options even hundreds of miles away, which is what many rural residents in Nebraska are doing, reports Destiny Herbers of Flatwater Free Press.

Arline Morris desperately needs oral care, but she lives in Stratton, Neb., more than 200 miles from any dentist that will take her Medicaid insurance, Herbers explains. "She can’t eat much and struggles daily with constant pain while taking medication that makes her teeth even more fragile. . . . She’s been offered appointments at Omaha and Lincoln. . . . [But] It’s an eight-hour round trip, plus hours of dental work. . . John Morris, Arline’s husband and sole caretaker, spends his days calling around for help, working around the spotty cell phone signal at their home. He’s talked to more than 50 dentists’ offices with no luck."

Over the past five years, "the total number of dental providers reimbursed after treating at least one Medicaid-eligible patient dropped by 37%," Herbers writes. "The problem is especially pronounced 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."

Why does Nebraska have low-income dental deserts? "Because it doesn’t pay," Herber reports. "State government reimbursements for this dental work have fallen 'far below market levels,' said Dr. Jessica Meeske of Hastings. They fail to cover the overhead costs of most procedures, leading to what Meeske calls a 'crisis level' with large numbers of patients unable to get care. . . . Meeske, a pediatric dentist at Pediatric Dental Specialists of Greater Nebraska, said her clinic turns away 15 families a day because they are 'overloaded and booked out.'"

Nebraska isn't the only state with dental Medicaid woes. The Rural Blog spoke to Gabriella Fryer in Orono, Maine; she and her husband, Cody, have three children ages 3 to 9, all of whom qualify for "Mainecare," the state's Medicaid program. Fryer described their experience: "There are very, very few dentists that accept Medicaid, even for kids, and ones that do have such [long] waitlists that you never get seen. A dental hygienist comes to schools, and that's the only way kids get seen and get referred to a dentist for cavities and whatnot." Fryer noted she and Cody opted to pay out-of-pocket to see a private-practice dental hygienist for preventative care, hoping to avoid dental problems in the first place. She adds, "That's not an option for everyone. . . . Mainecare says it "offers" dental care--but not really."

Florida is another state where low-income rural residents have limited dental care options because few dental school graduates choose to live in those areas, reports Lauren Peace of the Tampa Bay Times. "With fewer patients in mostly poorer rural communities, graduates flock to private practices elsewhere, seeking financial stability. . . . . Because Medicaid reimbursements for dental care are paltry, even in urban areas, most dentists opt not to serve Medicaid patients."