Report: La. has too few dentists for its residents

BATON ROUGE, La. (AP) -- Louisiana has one of the worst dentist shortages in the country, according to a new national report released Tuesday, only days before the state will slash its Medicaid reimbursement rates for dental care.

The analysis, released by the nonpartisan Pew Charitable Trusts, says more than 24 percent of Louisiana's population is underserved by dentists and living in an area with a shortage of dentists, second only to Mississippi and tied with Alabama.

In addition, nearly 42 percent of Louisiana's dentists are over 55 years old and nearing retirement, which could worsen the shortage, the study says.

The findings come as the state Department of Health and Hospitals is cutting reimbursement rates paid to dentists through the government-funded Medicaid program with the July 1 start of the new budget year, a move that dentists say will shrink access to services.

The health department announced the cuts late last week, saying lawmakers didn't provide enough money to continue all existing services and pay for expected increases in Medicaid program use.

DHH Secretary Kathy Kliebert said the 3-percent cut to the rates dentists are paid for taking care of Medicaid patients, mostly children, is a mild decrease to spending on dental care that shouldn't cause dentists to stop offering the care to the poor.

"It's a very minor reduction, and it still puts us ahead of our neighboring states in terms of the rates for most services," she said.

But those neighboring states also are listed by Pew as high shortage areas.

"What they've selected is two of the sorriest states in reimbursement rates to compare us: Mississippi and Alabama. What is our standard going to be? To get us to the bottom of the barrel?" said Dr. Edward "Don" Donaldson, a pediatric dentist in the New Orleans area.

Pew says that without early access to dental care, people are more likely to face preventable, but serious dental conditions that require more costly emergency room care.

Louisiana's $2.8 million budget reduction for Medicaid payments to dentists comes on top of recent cuts reaching 14 percent for the most frequently billed procedures, according to the Louisiana Dental Association.

Despite the cuts, Kliebert said the state has made significant improvements in boosting the number of children who receive dental services through the Medicaid program.

She said 30 percent of children in Medicaid received dental care in the 2007-08 fiscal year, compared to 43 percent four years later. She noted that the federal Centers for Medicare and Medicaid Services ranked Louisiana in April as one of the top 10 states for improved access to preventive dental care for Medicaid children.

Donaldson fought for years to boost reimbursement payments to attract more dentists to the program, specifically to treat children. He said increased services are because the payment rates had grown and persuaded more dentists to take Medicaid patients.

But Donaldson said that with current payment levels before the looming cut, dentists only get paid about half of what they receive for patients with private insurance.

"We need the average grassroots dentist that's out there that will go ahead and see these kids in the smaller areas. And they're going to say 'Hey, this is not worth us doing,' and they're going to bail out," he said.

Kliebert said DHH will track whether the payment cuts to dentists cause drops in the dental services provided through Medicaid and the department will make changes if there are access problems.

Donaldson worried that if dentists leave the Medicaid program, they won't return.