Are you now treating or have you ever treated indigent patients, either through a government program such as Medicaid or at a reduced out-of-pocket fee?
In October, the ADA House of Delegates adopted a resolution that provides a set of guidelines to be used in shaping federal legislation aimed at improving access to dental care.
Res. 45H also calls on the ADA to develop legislative models that constituent dental societies can use in their states to "address issues related to access to dental care for the underserved, indigent and special-needs children and adults."
In response to December JADA’s Question of the Month, 96 percent of the respondents said they currently treat or in the past have treated indigent patients through government programs or at reduced fees. "On occasion, why not?" asked a reader. "Let’s not be greedy."
"Try it and find out how great it is," said another.
Respondents said they accept Medicaid patients and provide care in their offices at reduced fees or at no charge. They also offer their services in their communities through their constituent and component dental societies, religious organizations, hospitals, clinics, Head Start programs, or special programs such as Maryland’s DDS—Donated Dental Services—program and Ohio’s OPTIONS—Ohio Partnership To Improve Oral health through access to Needed Services.
In response to the question, three dentists sent in copies of articles featuring their work in the community providing free or low-cost dental care.
Many respondents said they focus mainly on providing care to pediatric patients. "Children cannot protect themselves," said one. "Helping them is no question."
A few respondents noted that if all dentists provided free or reduced-cost dental care to a few indigent patients each year, more would have access to dental care. "I have these patients referred to me regularly by dentists who won’t treat them for financial reasons," said one reader.
"Unfortunately, those providers who do see patients at reduced fees end up overburdened since so few providers will see them," said another.
Ten percent said they participate in the Medicaid program, but on a limited basis because of reimbursements fees and time needed to file claims. "The paperwork and confusing multiple agencies in my state make treating these people unpleasant and costly to the practice," said a reader.
"It costs me less simply to provide free treatment," said another.
Another 10 percent of these respondents said they provided reduced-fee care or participated in Medicaid programs in the past, but will not any-more. "Government programs have fallen so far behind in fee schedules," said a respondent. "I cannot exist at their fee schedule."
"Youthful idealism was quickly crushed by the economics of running an office," said another.
"We saw [indigent patients] for 20 years and have not for 10 and will not," said one reader. "The cost is too great and far too many have the money, but choose to spend it on toys [and other items]."
Among the 4 percent of respondents who said they never have provided subsidized dental care, one said he chooses his own charities and another mentions low reimbursement rates.
Judy Pulice, director, ADA Department of State Government Affairs, said there is momentum in some states toward improving the Medicaid program’s budget and administrative requirements. For example, the state of Georgia is increasing its reimbursement fees and has received a grant for educating dentists about the increase and for studying plan participation.
