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Settlement May Help Poor Get Dental Care

By HILARY WALDMAN

May 16, 2008

For more than a decade, poor parents across Connecticut have complained about frustrating searches for dentists willing to take their cases, while their children cried in pain from rotten or broken teeth.

The problem became so severe that legal aid lawyers filed a class-action lawsuit eight years ago, accusing the state of violating the rights of 300,000 low-income residents who have been effectively shut out of dentists' offices by stingy state Medicaid rates.

But lawyers hope that the doors to dental offices will soon begin to open under the terms of a settlement that promises to dramatically increase state payments to dentists and remove some of the red tape that dentists say have made them reluctant to treat the poor.

Although the settlement is not scheduled to go to federal court for final approval until August, state officials and advocates for the poor said Thursday that many of the improvements mandated in the agreement are already being implemented.

The agreement effectively won legislative endorsement last week when the General Assembly's 2008 session adjourned without lawmakers turning it back.

"I feel extremely optimistic," said Jamey Bell, the lawyer with Greater Hartford Legal Aid Inc. who brought the suit in 2000. "I am really gratified that we were able to come up with what I think will be a tremendously improved system for families on Medicaid."

In the eight years that have passed since Bell filed the suit in U.S. District Court in Hartford, access to dental care for low-income families in Connecticut has gone from bad to worse.

Of about 2,237 dentists practicing in the state, only about 100 - a mere 4 percent - were available to treat large numbers of impoverished families.

Meanwhile, public clinics have been overwhelmed with patients while some school-based clinics that provided cleanings and check-ups were forced to cut back because of rising costs and stagnant payments.

Bell said the logjam in the lawsuit was finally broken last year when state lawmakers, moved by stories of children with painful toothaches waiting for weeks or months to see a dentist, agreed to spend an extra $20 million a year to boost Medicaid payments to dentists.

Once the money was there, Bell said, Gov. M. Jodi Rell's administration was willing to work out other details aimed at opening more clinics and private dental practices to low-income residents.

One cornerstone of the settlement is that it takes dental care out from under the umbrella of a managed-care system that in 1995 added strict participation rules to already low rates and drove the few remaining private practice dentists out of the Medicaid program.

Under the settlement, dentists will bill the state directly for the services they provide.

The settlement also provides higher payments to public dental clinics and awards $5 million in grants to bolster services at those clinics.

"The settlement provides a framework and the funding to begin a new era of provision of quality dental care not only for 230,000 children enrolled in Husky, but their parents and clients receiving dental services through other [state] programs as well," said state Social Services Commissioner Michael P. Starkowski in a letter to the Connecticut State Dental Association. Connecticut's HUSKY program provides medical coverage for uninsured children and teens.

Ronald Linden, a Shelton dentist, is helping to build a clinic in Derby that he hopes will be able to provide top-notch dental care, as well as flexible scheduling and patient education that he hopes will close the dental care gap between what he called the haves and the have-nots.

Because the clinic is being built with $1.1 million in state bond money, he said the overhead will be low and the newly increased Medicaid rates should be enough to sustain it.

"I'm hoping that this [new clinic] becomes a model for the entire state," Linden said

In April, Linden was among scores of volunteer dentists who spent a weekend in the gym of Tolland High School treating more than 1,000 people who lined up before dawn for the chance to have their teeth fixed for free.

Sponsored by the state dental association, the program called Mission of Mercy invited anybody who needed care for free treatment by dentists who volunteered their time starting at 5 a.m. on a rainy Saturday and Sunday.

Linden said the overflow crowd at the school underscored the atrocious state of dental care for needy people in the nation's richest state. He called the experience "a real eye-opener."

In two days, Linden said he cared for adults with decaying and broken teeth, and young children whose front teeth already were riddled with decay.

But he cautioned that the settlement doesn't automatically mean dentists will flock to Medicaid.

Even with the changes, he's not planning to open his private solo practice to low-income patients.

The extent of the problems and other factors, including poor nutrition and difficulty with transportation and phone service that often results in missed appointments, will still make it difficult to embrace low-income patients in a private practice, Linden said.