Maine Medicaid’s recent decision to pay dentists more to see Medicaid patients springs from its belated recognition that it is more difficult to get routine medical and dental care for adult Medicaid patients in many parts of Maine than it is to get your dog to do shovel the driveway (I know — I have tried both).
In the Bangor area, for example, there are currently only two doctors’ offices taking new Medicaid patients, according to local physician referral services. Every other primary care practice in the area has Medicaid patients in it, but none of those is taking new Medicaid patients. If you are a female Medicaid patient who needs a Pap smear and primary care in this community, good hunting. For every one practice that will take you in there are 10 that will turn you away.
There are no area dentists providing routine dental care to adult Medicaid patients, and few providing emergency care. If a Bangor-area Medicaid patient with a painful tooth abscess has no doctor, the patient must first go to a local emergency department to be seen, wait there for initial care, then get referred by the emergency department to the one oral surgeon on call in the community for emergencies. Bangor’s two emergency departments are essentially its adult Medicaid dental clinics, and neither one has a dentist in it.
The root cause of this access problem is that Maine Medicaid currently pays primary care doctors and dentists less to care for Medicaid patients than it costs to care for them. Medicaid has been paying about $20 for a dentist to pull a tooth (now being increased), and about $15 for a simple office visit to a doctor for the last several years. Neither fee has covered the cost of seeing the patient, unless the dentist is using a doorknob and string to do the extraction job, and the doctor is using a Ouija board to examine the patient.
Part of the humiliation for Medicaid patients in need is that no doctor or dentist has an ad in the phone book saying they don’t take Medicaid patients.
The patients have to call and be told by the office staff, usually after explaining need help. I have seen many Medicaid patients with tooth abscesses in the emergency department at 4 a.m. because they spent the previous day getting turned away from every dentist in town. Imagine being a patient in need of care trying to convince a doctor or dentist to help, only to be turned away again and again.
Access to these services is difficult for Medicaid patients in many areas of Maine. A Medicaid patient of mine who recently moved to Portland called all over that city before she found a doctor that would take Medicaid patients. Maine’s emergency departments, and the residency clinics run by the big hospitals, are among the few places doctors regularly see new adult Medicaid patients.
The problem is not unique to Maine, either. Across the country the road to health care for Medicaid patients often ends only in emergency departments, where the doctors cannot really take care of your high blood pressure until it gives you a stroke.
The solutions are straightforward. Maine Medicaid needs to pay doctors and dentists at least what it costs to see its patients, then survey Medicaid patients to see if they are able to get care after the rates go up. It should maintain a toll-free number for Medicaid patients to call and get the names of available doctors and dentists, so patients do not have to call office after office to get turned down.
Maine physicians and dentists need to do their part as well, easing access whenever possible and equitably sharing the financial burden of providing the care. They should not be expected to provide what amounts to charity care for a government insurance program that is inadequately financed. Access to routine health and dental care for Medicaid patients should be Priority One for the state’s dental and medical societies until the problem is solved.
There are two roads to routine health care in Maine; the one for Medicaid patients with a sign on it that reads, “Ayuh, awful hard to get there from here,” and a paved turnpike for those of us with private medical insurance. In the richest country on earth, and with a state government flush with cash, that is a violation of our social compact to provide care for the poor and an embarrassment of riches.
Erik Steele, D.O. of Bangor is the administrator for emergency services and pre-hospital care at Eastern Maine Medical Center and is on the staff for emergency department coverage at six hospitals in the NEWS coverage area.