Dental benefits widen, waiting lines grow

Two years into the state's bold healthcare experiment, its early success in expanding dental coverage may be threatened by a shortage of dentists willing to treat newly insured patients.

Since getting free or subsidized dental coverage in 2006, more than 200,000 low-income adults have climbed into Massachusetts dentists' chairs for work on their long-neglected teeth. But increasing numbers of patients are expected to seek care, and advocates fear the wait for appointments, now three months at community health center clinics, will grow.

The problem is that just 17 percent of dentists statewide have been willing to see these newly insured patients, despite reforms intended to boost their ranks. Even some of these dentists are limiting the number of state-subsidized patients they will treat.

Dentists say the state's reimbursement rate for adults covers only about half their costs, and they also cite payment delays and burdensome paperwork.

Without more dentists, said Kerin O'Toole, spokeswoman for the Massachusetts League of Community Health Centers, patients will not be able to get timely preventive care and "we risk treating people with more expensive and serious health issues."

As part of the healthcare law's goal of extending insurance to nearly everyone, dental benefits were restored to roughly 540,000 low-income adults who had lost nearly all dental coverage under Medicaid budget cuts in 2002. The law also expanded eligibility, prompting another 140,000 to sign up through Medicaid or the newly created Commonwealth Care subsidized program for the previously uninsured.

Suddenly, thousands of patients who had not opened wide in years were calling for appointments, and the number of Medicaid patients who saw a dentist more than doubled in the first full year, from about 15 percent of adults to 35 percent, state data show.

Among the newly insured is Pam Anasoulis, a 48-year-old telemarketer from Beverly who has also wired helicopter engines and fixed conveyor belts to make ends meet. For her, entree to the dentist after years of oral neglect was bittersweet. The mother of two grown children, she had broken a front tooth in 2004 and had gone to a dentist who filed down several of her front teeth to make a temporary bridge.

But Anasoulis said she couldn't afford health insurance and could not afford to go back to have the work completed. The bridge broke, decay set in, and Anasoulis was left with stubs for front teeth.

"You really don't think, when you look at someone with missing teeth, how much they're hurting inside," she said. "I got so depressed I didn't go out."

When she finally found her way to the Lynn Community Health Center dental clinic in 2006, many of Anasoulis's front teeth had to be extracted. But Dr. Herlivi Linares, the clinic director, was able to save some of her teeth and make her a partial denture.