NH Medicaid dental benefits expand, but providers remain a problem

  • Dental Assistant Terri Lapsley, left, preps Caitlin Caruso, of Claremont, N.H., for her appointment, which included fillings and a crown, at Community Dental Care of Claremont on Tuesday, April 18, 2023. Negative past experiences have made dental visits anxiety-inducing for Caruso, but she said the staff at the Claremont clinic have been accommodating and have helped her to feel more at ease. “It’s a really emotional experience for me,” she said. “They’re just awesome.” (Valley News / Report For America - Alex Driehaus) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. valley news / report for america — Alex Driehaus

  • Dental hygienist Brenda Collins does a cleaning for Dakota Eley, 17, of Charlestown, N.H., at Community Dental Care of Claremont in Claremont, N.H., on Tuesday, April 18, 2023. About 48% of the clinic’s 3,100 patients are covered by Medicaid. (Valley News / Report For America - Alex Driehaus) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Alex Driehaus

  • Dental Assistant Terri Lapsley arranges tools needed for a dental procedure at Community Dental Care of Claremont in Claremont, N.H., on Tuesday, April 18, 2023. As of April 1, New Hampshire Medicaid now covers fillings, cleanings, X-rays, extractions and surgery for adult patients with a $1,500 annual maximum that excludes preventive care. (Valley News / Report For America - Alex Driehaus) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. valley news / report for america photographs — Alex Driehaus

  • Executive Director Sally Bouchard helps a patient reschedule an appointment over the phone at Community Dental Care of Claremont in Claremont, N.H., on Tuesday, April 18, 2023. The clinic has received an uptick in calls from Medicaid patients since New Hampshire announced expanded dental benefits for adults. (Valley News / Report For America - Alex Driehaus) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Alex Driehaus

Valley News Staff Writer
Published: 4/18/2023 4:24:40 PM
Modified: 4/20/2023 8:06:36 AM

CLAREMONT — In the first two weeks after New Hampshire launched a new Medicaid dental benefit for adults, 75 Medicaid patients called Community Dental Care of Claremont, according to the executive director of the nonprofit that operates the clinic on Tremont Street.

“That’s a lot,” Sally Bouchard said in a Wednesday phone interview.

It has included people calling, emailing and stopping by the clinic, which has 3,100 active patients, 48% of whom are covered by Medicaid.

Most months, about 60 new patients with all types of insurance contact the clinic, Bouchard said.

Until April 1, New Hampshire Medicaid only covered three dental procedures: extractions, and X-rays and exams limited to problem areas. The new benefit includes fillings, cleanings and X-rays, as well as extractions and surgery. It also has a $1,500 annual maximum, excluding preventive services.

Not only are the numbers of patients seeking care large, but the degree of need some patients have also is large. On the first day the clinic was open after the April 1 rollout, two patients came in needing full-mouth extractions, Bouchard said. Those can cost as much as $7,000, she said. Bouchard said she emailed the state and they said they would figure out how to cover those patients’ extractions, but exactly how was not yet clear.

Sorting out how to ensure that the new benefit covers urgent care such as full-mouth extractions is just one challenge now that the several-years-long effort to create a Medicaid dental benefit for adults has been realized. Another question remains: Are there enough dentists willing to accept it?

Gail Brown, who directs the New Hampshire Oral Health Coalition that supported the benefit’s creation, said “it’s a wonderful benefit” and “quite comprehensive.” But she said getting it into place is “a big adjustment for all of us.”

Brown said the state now has 95 dentists accepting Medicaid, which is up from 75 before the new benefit rolled out. There also are another 18 dentists accepting New Hampshire Medicaid in border states, including Vermont, she said.

“That’s improving,” she said. “That’s a big deal.”

But she acknowledged that access remains an issue.

“One of the things we know is that the rural areas are a much bigger challenge,” Brown said. “There’s not a lot of health providers in some of these rural areas, never mind dentists.”

The Claremont clinic is currently the only dental office in the Upper Valley accepting New Hampshire Medicaid for adults. Some of the patients calling Community Dental live as far as an hour and a half away, Bouchard said. The Mascoma Community Health Center in Canaan, which accepted Medicaid, had to close its dental office last summer when the dentist left. The health center’s leaders have said they hope to recruit a new dentist and reopen the clinic later this year.

As a result of the new benefit, the options for dental care in the Upper Valley have narrowed by one, at least for some. Red Logan Dental Clinic in White River Junction, which provides care to people without insurance, has accepted dental patients with New Hampshire Medicaid because they were considered not to have a “comprehensive benefit,” said Dr. Kristin Bradley, the clinic’s manager. But with the new benefit, the clinic will no longer accept new patients covered by New Hampshire Medicaid, she said. The clinic will continue to see existing patients and those on the waiting list with New Hampshire Medicaid, however.

The clinic’s waiting list is eight months long, which is down from a yearlong list earlier in the COVID-19 pandemic. Patients who qualify can still apply for services.

“We’re keeping on keeping on with helping those folks,” she said.

Bradley said the clinic hasn’t yet figured out where to send patients who no longer qualify for the clinic’s care.

“We’re still figuring out where they should go,” she said. “We have noticed there are definitely more calls from that group, but it’s so new that we’re playing it by ear.”

Lebanon resident Matthew Keddie, 46, is among those seeking to use the new benefit. Keddie, who is in between jobs, said he hasn’t seen a dentist in about three years.

“The costs are atrocious,” he said.

He has “occasional” tooth pain and “definitely” has cavities. He has some broken teeth and had a partial denture, which he lost. He hopes to get into the Claremont clinic, but when he called on Tuesday they told him to call back in June or July.

“They said it’s because the program is so new and just began April 1, they are still getting it all set up with the insurance,” he said. “They did say, though, that if I was in any pain, that would get me in right away.”

Keddie isn’t alone. In the Upper Valley, there are roughly 8,000 adult Medicaid enrollees in Grafton County and 5,000 in Sullivan County, said Dr. Jay Maillet, dental director at DentaQuest, which administers the New Hampshire Smiles Adult Program. There are a total of 120,000 adult Medicaid enrollees across the state, he said.

In order to grow the network of providers who accept Medicaid across the state, DentaQuest is working to educate providers about the program; incentivizing dentists to join the network with sign-on bonuses, discounts with labs, and increased fees; reducing missed appointments by offering transportation assistance for qualifying enrollees; and providing patient case management and care coordination, he said.

While DentaQuest is working to encourage dentists to serve Medicaid patients in the state, Medicaid enrollees also now have coverage for teledentistry services. Those services mean that people with an internet connection or phone can connect with a dental provider trained to assess their situation and recommend the best next steps for their care, Maillet said.

“This can not only help keep people out of the emergency room for dental pain but can also help those with mobility issues, lack of child care options or the inability to miss work,” Maillet said.

In getting the word out about the new benefit, the New Hampshire Oral Health Coalition is focused on three main groups that have struggled to get adequate dental care in the state: adults with developmental disabilities, people in nursing homes and people in recovery from substance use disorders, said Brown, the coalition’s director.

Sylvia Kluge Dow, executive director of the nonprofit Visions for Creative Housing Solutions, which provides housing and support for adults with developmental disabilities in Enfield and Lebanon, said the organization’s residents rely on Medicaid for their health care.

Dow has seen residents opt to forgo treatment in the past, because preventive care and fillings were not covered by their plan and because they have very little spending money.

It “has been a hardship for many of our residents,” Dow said. The residents were able to take advantage of the Mascoma clinic while it was open, but even the sliding-scale payment structure was still expensive, she said.

Dow welcomes the new benefit and the preventive care it covers. But, she said, “My little bit of a worry is: Will all dentists accept Medicaid?”

Dow said she would like to see all dentists accept some Medicaid patients to share responsibility for that care. In the meantime, she said, she is hoping that the New Hampshire Bureau of Developmental Services will send a mobile dental van, similar to the mobile COVID-19 vaccine vans the state deployed, to Visions’ locations to provide care in a more accessible way for residents.

“We utilized the vaccine vans when they had them,” Dow said. “It was great.”

More information for participants in the program is available by calling 844-583-6151 or TTY 800-466-7566, or online at dhhs.nh.gov/programs-services/medicaid/medicaid-dental-services-new-hampshire-smiles-program-adults.

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

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