Why it’s nearly impossible to find an Iowa dentist who takes Medicaid

Laura Sauls of Dumont has two kids, and their pediatric dentist is only a 15-minute drive away.

That was, until that dentist called last fall with bad news: The office would no longer accept Medicaid, which meant they would no longer treat Sauls’ children unless she paid cash.

With the closest dentist accepting Medicaid over an hour away in Clear Lake—and without the ability to take that much time off—Sauls bit the bullet and paid out of pocket for both kids’ cleanings, exams, and one child’s X-rays.

It ended up costing her more than $400.

“It’s completely nuts,” Sauls said of the lack of dentists who accept Medicaid. “Basically, I’m obligated to travel an hour-plus to go to a dentist appointment for my kids? That seems unreal.”

But in Iowa, that situation is more and more common.

Fewer places to go

To be sure, the number of dentists dropping out of Medicaid—a program jointly administered and funded by the federal and state government—is a longtime problem.

Just 30 years ago, 62% of dentists in Iowa said they were willing to take “all new Medicaid patients,” according to a University of Iowa study. By 2013, that number dropped to 14%.

More startlingly: The number of dentists saying they would not accept any patients on Medicaid doubled, from 21% to 42%.

Yet the number of Iowans on Medicaid hasn’t gone down. An estimated 700,000 Iowans are on the program, or about 22% of the state’s population.

Iowa Republicans privatized state Medicaid in 2017, saying giving the program over to Managed Care Organizations would improve outcomes and save money. It has done neither.

Dentists are losing money

Out of 72 dental providers in four Northeast Iowa counties, just seven are listed as accepting new patients on Medicaid, according to Kaitlin Emrich, director of Black Hawk County Public Health.

“What we’re hearing from families, from dentists and dental offices, is the reimbursement is not covering the cost of providing care,” she said.

One of those seven dentists still taking Medicaid in the area is Dr. Alison Christensen, a dentist and owner of Waterloo Pediatric Dentistry.

While inflation has eaten into everyone’s budgets, “reimbursement hasn’t significantly increased for the procedures we’re doing in 20-plus years,” Christensen said.

That means dentists are faced with an impossible choice: Take a patient with Medicaid or one with private health insurance where they’re more likely to be fairly reimbursed.

“It’s very difficult,” Christensen said. “Unfortunately, in Iowa, reimbursement for dental procedures from Medicaid is quite low—low to the point where it’s even hard to cover overhead sometimes.”

Ultimately, Christensen says she continues to see Medicaid patients because of her education at the University of Iowa.

“They tried to instill in us that seeing this population is important—and if every dentist can see a few patients on Medicaid, the state will be better as a whole,” she said.

How the state can help

State legislators have the power to increase reimbursement rates for Medicaid programs and have occasionally done so for specific programs, like when they did so for children’s mental health last year.

Increasing reimbursement rates for dentists is a “top legislative priority” for the Iowa Dental Association (IDA), which represents the majority of licensed dentists in the state.

Specifically, this year the IDA has advocated to tie the rates for the Dental Wellness Plan Kids program (fee-for-service Medicaid) to Hawki, the MCO-managed program that generally pays dentists better.

“We believe this will allow more dentists to see more children who are on Medicaid, thus increasing access to dental care for the children in Iowa,” said Josh Carpenter, government affairs director for the IDA.