Report: High Medicaid reimbursement hasn't fixed ND dental care

A new report from the University of North Dakota (UND) found that the state is fighting the same distribution-of-care issues as many other states, despite having one of the highest Medicaid dental reimbursement rates in the U.S., according to the authors.

The report also indicates that American Indian and rural children have greater oral health issues, with American Indian children having high rates of tooth decay, untreated decay, rampant decay, and need for treatment. Titled the "Third Biennial Report on Health Issues for the State of North Dakota," the document was prepared by the UND School of Medicine and Health Sciences Advisory Council.

According to the group's findings, 12 of the 53 counties in the state have no dentists at all, nine counties have one, and another nine have two. Nearly 80% of the counties (42 of 53) have six or fewer working dentists. As in many states, dentists are located in the more populated areas, with two-thirds of licensed North Dakota dentists working in the four largest counties of Burleigh, Cass, Grand Forks, and Ward.

Additionally, North Dakota has 35 federally designated dental health professional shortage areas (DHPSAs), and there are 17 whole-county DHPSAs (Benson, Billings, Dunn, Golden Valley, Grant, Griggs, Hettinger, Kidder, McKenzie, Mountrail, Nelson, Pierce, Rolette, Sioux, Slope, Steele, and Towner).

North Dakota's dentist-to-population ratio is 6.1 per 10,000, which is well below the national ratio of 7.6 per 100,000, according to the report. North Dakota rural counties have half as many dentists per 10,000 individuals compared with metropolitan counties.

Somewhat ironically, despite this shortage, the number of licensed dentists in North Dakota (with a practice address) has slowly increased from 327 in 2007 to 380 in 2013. However, more than a third plan to retire sometime in the next 13 years, the report states.

Because of these gaps in coverage, only 30% of Medicaid-enrolled children had a dental visit in the last calendar year, according to the authors.

Dental assistants

What about other oral health providers, such as dental assistants? The state has two types: registered dental assistants (RDAs) and qualified dental assistants. An RDA has formal training or certification (or both) and has a greater scope of practice; a qualified dental assistant is trained chair-side, according to the report.

In 2012, there were 472 RDAs with an address in North Dakota and 107 RDAs without an address. Furthermore, 89% reported working the desired amount of hours, while 7% reported working fewer hours than desired.

As part of the goal to improve oral health delivery in the state, the authors of the report made five recommendations that were presented to the Interim Health Services Committee. The recommendations were subsequently passed by the committee and referred to the Interim Management Committee of the Legislative Council:

• Increase funding and reach of safety-net clinics to include providing services in western North Dakota.
• Increase funding and reach of the Seal! North Dakota Dental Sealant Program to include using dental hygienists to provide care and incorporating case management and identification of a dental home, where a patient receives oral healthcare in a coordinated manner on an ongoing basis (includes Medicaid reimbursement for services rendered).
• Expand the scope of dental hygienists and use them at the top of their current scope of practice to provide community-based preventive and restorative services and education to high-need populations.
• Create a system to promote the dentistry profession among state residents and encourage the practice in North Dakota through a consolidated loan repayment program and partnership, and look for student spots at schools of dentistry.
• Increase Medicaid reimbursement.