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The Affordable Care Act and Changes in Dentistry

There are very few dentists that participate in the Medicaid program in Wisconsin and I have heard a lot of complaints from patients about not being able to be seen if they have children on Medicaid or they were on Badger Care. One way to alleviate this would be to start a program for mid level dental therapists for at-need areas. The legislature would have to pass laws to allow this first which isn't any easy thing to do with Wisconsin's political climate right now.

Statistics in the search for dental care

It makes sense to have some kind of dental care rather than none at all. The cost ends up being more for the state or it can be seen as a loss of revenue for the hospital if there are no dental personnel available in their area or they do not accept Medicaid. In these cases patients use an emergency room for a dental visit. There were 830,590 people who did in 2009 across the U.S. Mid-level dental therapists would cost less in the long run.

Even when children qualified for dental care through Medicaid there were 52% who never went to a dental office across the United States in 2011. In that same year in Wisconsin 71.5% of Medicaid children never set foot in a dental office, according to studies done by Pew Charitable Trusts.

There were twenty-two states where most Medicaid-enrolled children did not receive dental care in 2011. Wisconsin was one of those states. Illinois was not.

The Affordable Care Act is supposed to make it better and easier for children in the United States to get dental treatment if they are under the age of 18. Most states have decided to cover preventive dental care as well as dental treatments (cavities filled, root canals, extractions). They have done this by choosing to use the Children's Health Insurance Program plan or the MetLife High Option plan according to the American Dental Association.

The lone exception to this is Utah which decided to only cover preventive care which includes cleanings, exams and sealants but not treatment for the children in their state under the Affordable Care Act. State legislators decide what to cover for the children residing in their states.

Under the Affordable Care Act a tax credit will be given to people purchasing a dental plan if it is purchased with a medical policy. If a medical plan does not offer dental along with it and it is a stand alone plan no tax credit will be given under the Affordable Care Act. It is best to get a dental plan along with a medical plan in order to get the tax credit on your income tax form.

Right now only 23 states and Washington D.C. have opted to cover adults in the way the Affordable Care Act recommends. The American Dental Association divided the categories of care covered by the A.C.A into

  1. None (AL, CA, DE, MD,NV, OK, TN, UT)
  2. Emergency (AZ, CO, FL, GA, HI, ID, IL, KS, ME,MS, MO, MT, NH,SC, TX, WA, WV)
  3. Limited (AR, DC, IN, KY, LA, MA, MI, MN, NE, NJ, PA, SD, VA, VT, WY)
  4. Extensive (AK, CT, IA, NM,NY, NC, ND, OH,OR, RI, WI)

Wisconsin made it to the Extensive Care list along with ten other states. This care is defined as "A more comprehensive mix of services, including many diagnostic, preventive, and minor and major restorative procedures. It includes benefits
that have a per-person annual expenditure cap of at least $1,000. It includes benefits that cover at least 100 procedures out of the approximately 600 recognized procedures per the ADA’s Code on Dental Procedures and Nomenclature" on the American Dental Associations web site.

Just how this new coverage will be implemented is yet to be seen. Federal funding for the Affordable Care Act was refused by the Governor in Wisconsin which in turn made premiums higher for residents enrolled in the Affordable Care Act to make up the difference the federal government was willing to kick in to help poorer residents of the state.

In case things stay the same in Wisconsin with dentists not being compensated properly for their services and patients are still tempted to use the Emergency room for dental care please refer to the Wisconsin Department of Health Services. They have a list of low-cost or free dental clinics online for adults not covered or having little extra money leftover from paying for rent, heat, clothing and food. Another option is to stand in line at a Mission of Mercy event or go to a Dentistry From The Heart event.

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