By relying on flawed data, the American Dental Association’s (ADA) recently released report, “Geographic Access to Dental Care,” severely overestimates the availability of dentists to treat the publicly insured. It uses faulty information to make wrong conclusions that hide how difficult it is for many Americans to get access to dental care.
The 50-state report by the ADA attempts to show the geographic distance between publicly insured children and dental providers that are enrolled in Medicaid/Children’s Health Insurance Program (CHIP). It also makes the dangerous claim that 98% of publicly insured children live within 15 minutes of a dentist who will treat children on Medicaid. Both of these claims are drawn from bad data.
First, to determine which dentists see children on Medicaid, the report relies on Insure Kids Now (IKN) — a national website that is known to be highly flawed. Second, what the report ignores is that even if dentists are enrolled in Medicaid on paper, it doesn’t mean they are actually treating publicly insured people. Finally, the biggest farce in the report is estimating dentist-to-Medicaid patient ratios based on the assumption that dentists on the IKN list are serving only publicly insured patients.
The ADA report also minimizes the size of the access problem. A 2015 attempt by ADA to verify IKN’s reliability found that nearly half (48%) of dentists contacted said they did not even practice at the location listed in IKN. Second, dentists that are listed as part of IKN are only asked if they enrolled in Medicaid/Children’s Health Insurance Program (CHIP), not whether they actually served any publicly insured children. That means that many of the dentists listed do not see any Medicaid patients.
Take Iowa for example: IKN says that 86% of dentists participate in Medicaid. But a survey from the University of Iowa from the previous year found that only 16 percent of private practice dentists accepted all new Medicaid patients, 42% placed conditions on accepting new Medicaid patients, and 42% would not see any new Medicaid patients. Yet, ADA’s latest report states that 93% of publicly insured children in Iowa live within 15 minutes of a dentist who accepts Medicaid.
Or look at my home state of Florida: According to the IKN database 30% of dentists here were enrolled in Medicaid or CHIP in 2014, and the ADA calculates that 96% of publicly insured children live within 15 minutes of a Medicaid dentist.
However, in reality, nearly 70% of Florida children on Medicaid went without a dental visit in 2014. Likely contributing to this gap is the fact that a 2013–2014 health department survey of dentists found that fewer than 23% of dentists reported treating any Medicaid patients, only 15% took new Medicaid patients, and a meager 10 % of Florida dentists reported treating at least 125 Medicaid patients.
The assumptions ADA uses to estimate Medicaid dentist “shortage areas” are also wrong. Looking again at Florida, the report estimates that 85% of publicly insured children live in areas where there is at least one Medicaid dentist per 2,000 publicly insured children within a 15-minute travel time. A 1:2000 population ratio would represent a reasonable caseload to reach Medicaid patients if each dentist were only treating such patients. But, as the above data reveal, most Florida dentists serving publicly insured children are also serving other patients. In fact, most dentists serving publicly insured patients serve a majority of patients that are not publicly insured.
In reading ADA’s analysis of Florida access, Scott Tomar, DMD, epidemiologist and my colleague at the University of Florida College of Dentistry, noted that the estimates “have several major sources of error that resulted in the misleading appearance that there was adequate access.”
As if there aren’t enough issues with the report, the IKN list only identifies dentists who have enrolled to treat Medicaid children, not adults. The number of Medicaid adults with access to a dental benefit has grown by millions as 23 states now offer at least limited dental care to some adults. Yet ADA’s report tells us nothing about this population.
The lack of access to oral health care is a serious issue in our country. One only needs to read the recent Washington Post story about adults standing in line for hours to get care to get a picture of real life for too many Americans. Nearly 40 percent of U.S. children, and more than 50 million children and adults overall rely on Medicaid as their dental insurer. This doesn’t even count the many don’t have any insurance at all, but if we are truly going to understand the magnitude of the oral health access problem for the publicly insured, and to respond accordingly, we need to rely on facts.
Here’s an important fact: ADA’s overinflating the availability of dental care for children on Medicaid may steer state policymakers away from measures they need to consider to improve access for this population. Low-income Americans deserve more and the ADA should do better.