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One in seven eligible adults have already accessed newly expanded Medicaid dental care

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Charles Rex Arbogast
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Dr. Velma Barnwell is proud of her tooth extraction skills. She recently had to pull four out of a patient who has diabetes and hypertension. But as proud as she is of her technique, what she’d really like is to do fewer extractions, and more preventative care.

It’s important, says Barnwell, to not feel limited by what a patient can afford.

“I can do what they need,” Barnwell says. “So I don’t have to do one filling at a time. If they’ve got a quadrant and I can do it, I can get it done, And get it done well.”

Barnwell is the staff dentist at Crossover Healthcare Ministry in Richmond. She recently went from part-time to full-time hours, thanks in part to a recent expansion of dental insurance from Medicaid.

It’s been a little over six months since Virginians with Medicaid also began receiving dental insurance. Virginia’s Department of Medical Assistance Services estimates that in that time more than 100,000 people have gotten dental care.

Crossover CEO Julie Bilodeau says that thanks to the expansion, the clinic has been able to bill for services they used to provide for free. Ultimately it’s meant serving more patients.

“And so it has allowed us to increase our resources to provide that care that they need, which has been I think transformational for many of them who have not had dental care for five to ten years,” says Bilodeau.

Low-income adults with Medicaid used to only have coverage for extractions or other emergency dental services. Last July that changed and now Medicaid covers cleanings and other care, with no copays or deductibles. Healthcare providers called it a game-changer, stressing that dental care is healthcare.

Barnwell couldn’t agree more. She says a lack of oral hygiene can be a contributing factor in pneumonia, cardiovascular disease, even low birth weights for babies. Barnwell puts it plainly: “You can’t eat and stay healthy without teeth.”

According to the state agency that runs Medicaid, the Department of Medical Assistance Services, about 1 in 7 of those eligible have already accessed the new benefits.

“Clearly the need was there,” says Karen Kimsey, director of DMAS. “And we're just so pleased that…the Commonwealth has been able to step up and meet that critical need.”

Kimsey says so far they’ve seen billings for almost 50,000 dental cleanings, and 117,000 restorative treatments – that’s things like root canals or cavity fillings. They’re also seeing the number of emergency room visits go down.

“If you know you're in the ER for a tooth, you're in a lot of pain,” Kimsey says. “This will help people not have to be in so much pain… It also helps our hospitals. They're dealing with other COVID related things right now and overrun. So this helps our systems.”

One of the biggest challenges now, though, is getting more dentists on board.

Adina Keys is Clinic Director at GoochlandCares. They recently decided to expand dental services after learning that none of the five dentists in the county had space to take on more Medicaid patients.

“So when I went to each one and asked their offices or their staff, did they plan on expanding their services with the new Medicaid benefit, and most said, we’ll be able to keep the Medicaid patients that we have, the two that did it, but we're not going to be able to expand services,” says Keys. “So definitely left a gap for our community.”

Free and charity care clinics like GoochlandCares and Crossover have been trying to fill that gap, but they still rely on volunteer dentists and may have long wait times for an appointment.

Private practices often choose not to take on Medicaid patients because reimbursement rates for dental services haven’t increased since 2005. Dentists can make more by filling appointment slots with private insurance which pays more.

Fixing that problem is now in the laps of lawmakers, who are drafting the state budget and considering an increase to reimbursement rates.

This report, provided by Virginia Public Radio, was made possible with support from the Virginia Education Association.

Mallory Noe-Payne is Radio IQ's Richmond reporter and bureau chief.