Op - Ed

Moving Medicaid forward

Dr. Stephen Pitmon

Vermont’s secretary of human services recently saluted the 50th anniversary of Medicaid. As the secretary pointed out, there’s much to celebrate. There are also many elements of the program that must be reformed if Vermont is to succeed in making health and dental care affordable for everyone.

First, state government must acknowledge health care providers as equal partners in this program; it is not just a state and federal partnership. After all, it is the caregivers, not government administrators, who serve patients.

Second, and most important, we must not brush aside the extreme financial pressures the program creates for both medical and dental doctors. When Congress created Medicaid it was a revolutionary program providing access to care for people who otherwise couldn’t afford it. In the ensuing half century, Medicaid has improved millions of lives. With the passage of the Affordable Care Act and other state initiatives, the number of people eligible for Medicaid expanded. But government funding levels and administration have not kept pace, stretching an already frayed safety net to near its breaking point. Without substantial reform, Medicaid is at risk of collapsing.

Today in Vermont, the challenges of multi-generational poverty, underemployment (many Vermonters have to work more than one job to afford living here) and slow wage growth create an environment where Medicaid is necessary more than ever. Nearly two-thirds of Americans and at least as many Vermonters have either benefited directly from Medicaid or have a family member or friend who has. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provision requires states to cover comprehensive dental care to Medicaid-enrolled children. In some states, like ours, these kids receive dental care at rates equivalent to those covered by private insurance. But most state Medicaid programs, including Vermont’s, fail to provide adequate care to adults.

Nationally, the average state Medicaid program allocates less than 2 percent of its budget for dental services. And even then reimbursement rates paid by the government program are far below–frequently less than half–of what it costs to deliver the care.

These dangerously low funding levels and reimbursement rates are the obstacle to expanding care. They make it very difficult, often impossible, for many dental or medical practices to add new Medicaid patients. They also result in the shifting of costs onto other Vermonters–a large, hidden tax in their insurance premiums.

Outdated government administration is also a challenge. The system relies on the same core processes implemented nearly half a century ago. Here we are in the 21st century, yet initial credentialing to qualify as a Medicaid provider can take months. There are also excessive paper-based administrative burdens and other disincentives for dentists who might otherwise participate in the program.

As citizens, we should expect innovations in government’s administrative systems to keep pace with innovations in medicine and science. Millions of dollars get diverted from direct patient care—and other social services—to operational and administrative expenses of an outdated bureaucracy.

To be clear, this is not the fault of state employees. They’ve been burdened with an outdated system that no longer meets the needs or the expectations of the 21st century patients and taxpayers.

Elected leaders must be willing to exercise the disciplined fiscal leadership necessary to make the program sustainable for the future. Sadly, many lawmakers blame dentists and doctors for not serving more Medicaid patients. In reality, it is the inefficiency and underfunding of Medicaid that is the greatest barrier to care for more low income Vermonters.

We can put good oral health within reach of all Vermonters. And if we hope to preserve Medicaid for another 50 years, lawmakers must acknowledge the program needs reform and the coverage must be adequately funded. That is why it is a core component of the Vermont Action for Dental Health plan. Learn more at www.VTActionForDentalHealth.org

Dr. Stephen Pitmon has practiced dentistry for 25 years. He is president of the Vermont State Dental Society.

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