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Wednesday, April 26, 2000 Missoulian Editorial

Thirty agencies, more than 1,000 people on one waiting list and hundreds more uninsured families aren't wrong: Of course Missoula has a problem with access to dental care.

Three years ago, the Missoulian did its own telephone survey of every dentist in the county. Just about every single call ended with the same answer: Sorry, we aren't taking anyone on Medicaid or without insurance.

The problem remains unresolved. Poor families still have trouble finding a local dentist willing to take them as a new patient.

Last week, the Missoula City-County Health Department decided to ask the federal government for help. Board members are writing a letter to the Department of Health and Human Services to advocate Missoula getting a "HPSA" designation - a Health Professional Shortage Area designation for dental care, which would give the county a competitive edge for grants, programs and other aid.

Health-board members voted unanimously to write the letter. They've been battling the same problem for years, and the numbers keep getting larger.

Controversy arose from dentists themselves, some of whom argue there is no shortage of professionals, just money. Montana doesn't pay them enough to care for Medicaid patients, which is why most dentists limit the number of Medicaid clients in their practices, some said.

Dentists have a point. Montana pays very little to cover dental care for Medicaid patients, especially for adults. Dentists who charge about $35 for a regular check up to most patients would get just $11 from the state for an adult Medicaid patient, for instance; fit a crown, and the reimbursement rate is 65 percent of the usual charge.

Montana has made progress toward better coverage for children. It pays for their care at a higher rate, correctly arguing that proper dental care given early in life pays off later. A periodic exam for Medicaid children, for instance, is reimbursed at $16, instead of the $11 for adults.

The problem is not just for Medicaid patients, but for uninsured patients, too.

As a group, Missoula dentists are not a sympathetic lot. Through the years they've exerted more energy fighting local solutions than offering sustained help; overall they seem less attuned to the humanitarian side of health care than their counterparts in other medical fields. There are exceptions, of course: About 20 local dentists now volunteer their time and skills through Missoula's Partnership Health Center, a public clinic that serves mostly the working poor, and others provide charity care in other ways. Dental hygienists also have stepped forward in great numbers to help.

Montana is expecting more of its poor families as they move off welfare and learn to get and keep a job and juggle work and family. Chronic pain, infected teeth, bad dental care will only keep them from achieving these goals.

Next year's Legislature should increase the reimbursement rates for Medicaid dental services.

But the need for Partnership Health Center's dental program is not going to evaporate. More than 1,000 people are on the waiting list to get help from the few dentists who volunteer. Probably a thousand more don't bother to sign up because the waiting time is so long. Emergency-room doctors see cases every week of people who've been refused care at dental offices, but whose untended teeth lead to infected mouths and terrible pain.

Missoula's City-County Health Board has always welcomed local, private help to tackle public health problems. If that isn't available, or if it comes in short or unsteady supply, then other solutions are sought. In the case of dental care, board members deserve credit for taking extra steps to help the poor and the uninsured in Missoula.

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