Florida does the worst job in the nation of ensuring poor children get dental care. Now it's expected to do even worse. Changes to the state's Medicaid system appear likely to make it impossible for the vast majority of young enrollees to obtain preventive care, increasing the odds of toothaches and disease that can have costly lifetime consequences for children and society. Florida can do better, and Gov. Rick Scott and the Legislature need to see to it.
As the Tampa Bay Times' Jodie Tillman and Claire McNeill described, the state's decision to shift all dental care for 1.5 million children on Florida's Medicaid plan to managed care appears to be shrinking the already shallow pool of dentists who serve the population. The state program has long been plagued by low reimbursement rates, resulting in just 15 percent of dentists participating. But now even some of those providers are exiting the program, saying they can't afford the hassle — on top of low fees — of obtaining credentials with the companies or having to constantly seek authorization to serve patients.
Lawmakers initiated the managed care scheme three years ago to save money. But patients had the option to stay in the old fee-for-service model. That option went away July 1. Now anecdotes from dentists who have already experienced the managed care process are discouraging. Dr. Sandy Worman, a St. Petersburg pediatric dentist, told the Times, "Half the time the patients come in in pain, and you have to send them home (without treatment)."
Here's an even bigger problem. Before these new hurdles took effect, Florida already was doing a miserable job of providing dental care for children on Medicaid. For every child who saw a dentist, three more did not. A new Pew Charitable Trust survey found that in 2011, 76 percent of Florida's child Medicaid enrollees failed to receive dental care — the worst rate in the nation. The state also ranked last for 2010.
Florida can do better, for children and for the greater social good. A child without professional dental care runs a greater risk of disease and infection that can interfere with eating, sleeping, speech, schoolwork and the long-term development of adult teeth. Children without adequate dental care face significant long-term financial implications, from obtaining a job to paying for future dental work. But there are also serious implications for taxpayers. Two preventive visits a year for a child would likely cost the state less than one visit to an emergency room for a toothache or the education loss when a child is in too much pain to pay attention.
The reality of what Florida has wrought is finally dawning on some legislators. Retired dentist and state Sen. Alan Hays, R-Umatilla, told the Times he regrets voting for the managed care system, which he calls "an embarrassment and a nightmare." Hays should keep beating that drum until he gets the ear of the governor and fellow lawmakers, including House Speaker Will Weatherford and Senate President Don Gaetz.
Florida can do better by its children. The nation's fourth-largest state should never accept being the worst at preventing disease for its poorest children.