Upper Valley dental services keep getting yanked, especially for Medicaid patients


Valley News Staff Writer

Published: 07-16-2022 9:59 PM

CANAAN — Mascoma Community Health Center will suspend its dental services beginning July 30, following the departure of the center’s current dentist, according to a news release from the nonprofit’s board.

The suspension of services leaves about 1,500 patients at least temporarily without a dental home amid a broader dearth of dental care in the region.

“We had no choice,” Sandra Hayden, chairwoman of the Canaan health center’s board, said Thursday. “Without a dentist, we couldn’t continue hygiene visits.”

The center’s dentist, Dr. Navpreet Judge, who has been in his post since last August, is leaving to enter private practice in southern New Hampshire, Hayden said. His departure means there will be no one to supervise the remaining three employees on the dental side of the health center. Those employees will lose their jobs at the end of the month.

The suspension of dental services in Canaan further narrows the options available to patients in the Upper Valley. It comes on the heels the retirements earlier this year of dentists who accepted Medicaid in Randolph and Bath, N.H. And, like the Mascoma Community Health Center, the Ammonoosuc Community Health Services dental clinic in Littleton, N.H. also has closed due to staffing shortages.

“I’m sadly not surprised,” Ed Shanshala, Ammonoosuc Community Health Services’ CEO, said of the Mascoma clinic’s suspension of services. “Part of it’s funding; part of it’s staffing.”

Nationally, Shanshala said, there aren’t enough dentists. In addition, many younger dentists want a more urban or suburban experience, and he suspects the pandemic accelerated older dentists’ retirement plans. Combined, he said, these factors have created “kind of the perfect storm” for the industry.

Alice Ely, executive director of the Public Health Council of the Upper Valley, said patients’ concerns about finding a dentist who will accept their insurance have come up in community health needs assessments.

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“There’s clearly a shortage,” Ely said. There’s “clearly concerns about how much it costs and whether or not you can get a provider at all. We know that this is, as it’s been for a long time, a challenge in the Upper Valley.”

Ely noted that the suspension of dental services in Canaan comes as New Hampshire has recently enacted a law paving the way for a Medicaid dental benefit for adults. Previously the approximately 90,000 adults covered by Medicaid in New Hampshire had coverage only for emergency extractions, not preventive care. The new benefit is slated to begin in April, but it’s unclear how much that will improve access to care.

“We don’t know how many private practice dentists are going to start to accept Medicaid because of this,” she said.

The Mascoma health center was one of the few dentists in the Upper Valley accepting Medicaid, so the suspension of its dental services “is really a blow to those patients as well as a large number of people who are looking for dentists particularly now that this new benefit is available,” Ely said.

Dr. Sarah Finne, Medicaid dental director for the New Hampshire Department of Health and Human Services, said she and others at the department are busy getting ready for the new benefit’s launch next year.

“I feel badly that it took this long to have the adult benefit passed,” she said.

The benefit — which covers preventive services as well as transportation, care coordination and up to $1,500 annually in restorative care — could help organizations such as Mascoma and Ammonoosuc fund their dental services, she said.

It’s a “piece of the puzzle for certain facilities to be sustainable,” she said.

Ely said she’s concerned about a trend over the past year or so in which government programs have been set up to give people money to expand their access to services such as oral health care or child care.

“But all the money in the world to help people pay for the service will do nothing if there’s nobody to pay to do the service,” she said.

The suspension of services in Canaan underscores the fact that demand for services, be it dental care, child care, mental health counseling or substance use treatment, is not driving up supply.

“I would just say that this situation in Mascoma is one example of how we won’t be able to play catch-up if we don’t really turn our laser focus toward the question of who’s going to do the work,” Ely said.

Finne said as part of the new Medicaid benefit, the state is working with the New Hampshire Oral Health Coalition, Bi-State Primary Care Association and the New Hampshire Dental Society to address workforce issues, which she said are a national challenge, not unique to New Hampshire.

“There are a lot of people who are on this,” she said. “We are trying a number of ways to turn this around.”

Michael Auerbach, executive director of the New Hampshire Dental Society, said the society is working with Bi-State to develop a dental residency program with the Harvard School of Dental Medicine, and working with the state to develop a program aimed at helping dental students pay off debt.

“The area of the Upper Valley is a wonderful place,” Auerbach said. “We’re trying to build more pipelines.”

The workforce shortage extends beyond dentists and also includes hygienists, dental assistants and office managers.

“Every sector of the economy is dealing with this,” he said.

Of the three employees who are losing their jobs as a result of the suspension of dental services in Canaan, Auerbach said, “I’m sure they will be quickly snapped up.”

The Mascoma health center plans to resume dental services when it can find a replacement for Judge, but it’s unclear how long that may take.

Hayden said Judge, who was busy seeing patients on Thursday afternoon, declined to comment for the story.

So far, the health center’s leaders have tried for 12 weeks to find a new dentist, advertising online, in newspapers and through universities and colleges with dental schools.

“We haven’t had one candidate,” Hayden said. “We realize the shortage spans not just New Hampshire but the whole of New England.”

Meanwhile, Hayden sought to emphasize that the medical services the center provides are unaffected by the halt in dental services. The center, which first opened in 2017, has more than 5,000 primary care patients.

“We’re vibrant and still growing with patients,” Hayden said, noting that the center has a new nurse practitioner starting by September. “I don’t want people to get the impression that we’re closing our doors.”

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.