If given more from MaineCare, dentists can improve oral health in Maine almost overnight.

In the current state budget crisis, I know policymakers can’t always see the forest for the trees – especially in MaineCare. Yet, to choose which programs to fund and which to cut, it is important to remember the old adage, “An ounce of prevention is worth a pound of cure.”

LD 624 is a bill aimed at prevention. It seeks to nip oral health problems in the bud – and in the long run, save MaineCare considerable money. LD 624 would increase reimbursement rates for dental services, so a safety net of clinics could stay open and hopefully, more dentists would participate. This means more people would be treated in the early stage of dental disease, thus decreasing future MaineCare costs.

Passage of the bill may be unlikely, despite its significant benefit to the lives of Maine’s low-income residents. It carries a price tag, and requesting increases in a budget overflowing with red ink is to risk a quick defeat.

The MaineCare fee increase is the priority recommendation from the governor’s Task Force on Expanding Access to Oral Health Care. The increase can help provide a lifeline for thousands of Maine children who do not have access to basic dental care. It can also sustain the safety network of dental clinics that struggle to survive on low reimbursement rates.

Recently, a dental clinic was forced to lay off staff because it could not meet payroll. MaineCare fees were too small to cover the actual cost of treatments, and red ink could only be tolerated for a short time. For private dentists, the loss of money from MaineCare can be softened by filling the dental chair with self-pay and insured patients. Safety net clinics don’t have that option, as their patient base is primarily the uninsured and the working poor.

In its original form, the legislation sought to increase MaineCare reimbursement fees for 17 dental procedures. Today, these dental procedures are reimbursed at the tenth percentile, which means 90 percent of New England dentists charge more for the procedure than MaineCare reimburses. This is not an easy concept to grasp – but in simple terms it means that dental offices lose money when they accept MaineCare clients.

Over time, this loss cannot be sustained.

The governor’s task force, in looking at many options to enhance access to oral health care, agreed that increasing MaineCare reimbursement fees would have the quickest and most direct effect of helping people receive the dental treatment they need.

An increase in MaineCare fees would keep dental clinics operating at full capacity. It would also encourage more private dental offices to participate.

Currently MaineCare has fair participation by Maine dentists. Maine ranks about 20th in the nation in the number of dentists participating, and about ninth in terms of dentists who provide more than $10,000 worth of MaineCare treatment each year. This is far better than some states, but we can do better. It has been many years since reimbursement rates were increased.

LD 624 was scaled back from 17 to 12 procedures to reduce the cost and, hopefully, make the bill more palatable. The 12 services include exams, cleanings, fillings and extractions. They provide patients with the foundation for long-term oral health – saving them from pain and disease. Adequate funding for children’s services will support a larger provider base. This will save money in the long run by eliminating the too-common situation of emergency room visits.

While I understand the challenge of cobbling a budget amidst of an economic downturn, taking the long view is still an important approach, especially in matters of health.

I urge policymakers to look closely at LD 624. The benefits it can provide must be carefully evaluated, not only to individual Maine people who deserve basic services, but also to future MaineCare budgets. Having dental clinics cut their services, or face closing, will cost much more money in the future than the $3 million price tag on LD 624.

Dr. Kristina Lake is a general practice dentist in Lewiston.


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