Jack Klure has been working as a dentist for 40 years, half of those in the Boise area. He sees 30 to 40 paying customers a week who have private health insurance or pay cash.
But he and other Idaho dentists say they have given up on seeing Medicaid patients — a group that includes many Idaho children — because the government health insurance doesn’t pay enough, so they are pushing for higher reimbursement rates.
The state’s Medicaid reimbursement rate to dentists is slightly below the national average. As a percentage of the dentists’ full-price fee, reimbursements have decreased about 25 percent over the past 10 years, according to the American Dental Association.
That is driving down the number of dentists who are willing to take Medicaid patients, according to Linda Swanstrom, executive director of the Idaho State Dental Association.
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Fewer than 500 dentists in Idaho take Medicaid at all, Swanstrom said. Nearly 200 of those have specified that they are no longer accepting new Medicaid patients, she said.
Duston Connaughton, a dentist who owns Tree City Family Dental in Boise, ceased taking new Medicaid patients about five years ago. The existing ones make up about 7 percent of his practice — about 120 Medicaid patients, mostly children. He said he feels an obligation to meet some of the demand.
It costs me money to deliver that care. ... So there are many other dentists that are saying, ‘I’m not going to accept Medicaid payment; I’m going to give it away for free.’
Duston Connaughton, dentist, Tree City Family Dental
“I would feel badly not having those patients,” Connaughton said. “We get calls literally every day from patients looking for somebody who will accept Medicaid. And because I’m a Medicaid provider, my name shows up on the list. ... But then the answer they hear repeatedly is, ‘I’m sorry, but we’re not accepting new Medicaid patients.’ ”
Connaughton and Klure said they believe that for all dentists, it costs money to take Medicaid patients.
Instead, they and other dentists have begun seeing a handful of Medicaid patients on a pro-bono basis.
21% to 45% Medicaid payments as a share of dentist Duston Connaughton’s normal fee
82% A typical private insurance plan’s payment as a share of his normal fee
Klure volunteers once a month at a local clinic that serves Medicaid and uninsured patients. There, he usually sees six to eight patients. He also sees the occasional patient for free in his own practice.
“Frankly, I don’t know of any Medicaid that comes into (my) practice,” Klure said, noting that he may continue to see existing patients if their life situations changed and they became insured by Medicaid.
Connaughton takes care of about 30 adult patients who have severe disabilities, but he sees them only in the hospital, under anesthesia.
“These are patients that have an inability to receive dentistry in a normal office setting,” he said. “That’s a portion that has increased, and it’s been a real challenge for me from the perspective of running a business, because the reimbursement rates are so low, and when I go to the hospital I can treat only three or four patients in a day.”
The hospital services end up costing him “thousands of dollars,” he said.
A typical patient may need $2,000 of work, based on Connaughton’s normal fee, and Medicaid would pay about $600 for that, he said.
“I hope we can get more funding, or at least a different way to manage that funding,” Connaughton said. “I just know that the current system is broken.”