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MyView: State's failed dental therapy experiment

April 16, 2018

By Robert S. Roda, D.D.S.

Photo of Dr. Roda
Robert S. Roda, D.D.S.
Earlier this decade, Minnesota lawmakers were convinced they had the solution for rural and low-income people not obtaining oral health care. Create a new midlevel provider called a dental therapist and all would be right in the world.

What has happened instead should be a cautionary tale for Arizona, where an East Coast foundation is peddling the same off-target solution. While the Pew Foundation and its allies declare Minnesota's dental therapist experiment a spectacular fireworks show, it's really nothing more than a few people standing around waving sparklers.

Since that vote seven years ago, the percentage of Minnesota's Medicaid children receiving any dental service has stubbornly remained around 41 percent. Adding almost 80 dental therapists didn't budge the rate at all. Nor did it reduce dental costs. And now the federal government has put the state on notice: It is at risk of having federal Medicaid money withheld.

In contrast, 49 percent of Arizona kids on Arizona Health Care Cost Containment System — the state's Medicaid agency — had a dental visit last year, about the national average. That's still not high enough, but increasing the rate comes from understanding why kids aren't getting oral health care. It's not because of a lack of providers. We need real solutions that address real issues.

Minnesota shows us why. After seven years of expecting dental therapists to fix the problem, Minnesota's elected officials are scrambling to get more children into dental chairs. Nowhere to be found is any suggestion to add more dental therapists.

Instead, the governor asked for a substantial increase in Medicaid dental reimbursement rates, which are so low that dentists won't sign up. Legislators, having been assured dental therapists were the panacea, saw no need to raise those rates.

They're just now realizing this was never a workforce problem; Minnesota has plenty of dentists. The legislature there wasted time and energy creating a new kind of professional, while ignoring the real barriers to access.

Just as in Minnesota, Arizona does not face a workforce shortage. Indeed, 90 percent of publicly insured children live within 15 minutes of a dentist who accepts state Medicaid patients.

Higher reimbursement rates would help attract more Arizona dentists, but the bigger challenge is that Arizona's Medicaid system limits the number of dentists who can sign up. I personally know dentists who would accept state Medicaid patients but have been turned down by the state's contracted insurance plans. Adding dental therapists doesn't fix that bottleneck.

Allowing any willing dentist into the program would increase access for children. And there's more we should be doing, like focusing on the real challenges that parents face in getting their kids to a dental office. We should continue to be creative in expanding preventive services to avoid tooth decay in the first place. We can effectively do this with our existing dental team and the solutions dentists advocated and legislators approved.

Dental therapists are a distraction. They solve nothing. Legislative efforts to bring this position to Arizona divert attention from the real issues and real solutions. They set us up to be the next Minnesota, scrambling a few years from now after we learn that Pew's hollow promises only delayed the day of reckoning.

Let's not go there. Let's work together on solutions that will really make a difference.

This editorial, reprinted with permission, first appeared in the Arizona Capital Times on March 29. Dr. Robert S. Roda, a Scottsdale, Arizona, endodontist, is president of the Arizona Dental Association.