Medicaid and the Reality of special needs dentistry
A more in-depth look at a recent report and other data.
In case you didn't already know it, being poor can cost you in more than dollars; and having special needs can cost you even more.
In a new study released by the journal Pediatrics, kids on Medicaid were reportedly 38 times more likely to be denied an appointment by any dentist, but were also 18 times more likely to be rejected by dentist offices who said they accepted Medicaid and other public forms of insurance.
This snapshot validates prior studies about the overall disparity between those on Medicaid and those with private insurance who are looking for care. As this news article from the LA Times pointed out, though, the difficulties of children with special needs finding coverage is a verified issue as well.
How Medicaid impacts special needs children
I'll share a little secret with you. My guys are on Medicaid. I don't need a study to tell me something I have already witnessed over the years. After years of having great insurance with my husband's former employer, he lost his job and we found ourselves with two special needs children (this was before Logan joined the Moody gang) and no insurance.
The boys needed surgery; they needed to see specialist after specialist. They needed--they needed so much. We turned to Medicaid. And while we were thankful to eventually receive the benefits for our children, and while we grumble about the coverage sometimes, I couldn't begin to tell you how often we have been stigmatized simply because our children receive this needed resource.
This is how it works when you have a child who needs services, who has special needs: you fight for Medicaid because your regular insurance won't pay for everything your kids need and you don't want your family to go bankrupt; you still amass thousands, hundreds-of-thousands of dollars, worth of bills because this procedure or that specialist isn't covered; so you finally fight for and receive Medicaid; and then you fight to find a specialist your kid can see.
It's this convoluted approach where you fight to prove your child in need of services, and then once they get those services you fight public perception about them having those services, those services that they need because of their special needs. What about public perception? How does that fit into a discussion about dentists or other doctors denying a child an appointment?
The circle of discontent
It goes something like this: you reach out, desperately, for services like Medicaid because you need every resource you can get to take care of your special needs child. Instead of seeing the need, other people--people who don't understand your very real needs--are quick to point out how lazy, how shiftless, how irresponsible you are because you can't pay for your kids' insurance yourself. You research more specialists then you ever thought possible because so many offices are strangely 'unable' to see your kid anytime this year, or they don't think they could handle having a kid with that degree of special needs to be responsible for, or because they don't take Medicaid.
The sad reality is that Medicaid as a service is utilized by millions of kids and families, millions of families struggling to find coverage for someone with special needs. And there is still a stigma attached to being one of those millions who need the benefit.
Medicaid does a lot of good.
Numbers released in February by the non-partisan Kaiser Family Foundation (KFF) stated that one-third of all children and fifty-nine percent of all low-income children are covered by Medicaid or another program that insures children, the Children's Health Insurance Program (CHIP).
In her 2008 testimony before Congress, Executive Vice-President of KFF Diane Rowland said that while Medicaid is known as a primary "source of health insurance coverage for millions of low-income children and parents, the program has become the largest single source of health insurance and long-term care and the largest source of public financial support for people with disabilities." [emphasis mine]
The problem is that if you or a loved one has Medicaid, though, it is harder to find an appointment when you need it, even in emergency situations. Consider that if your child has special needs, the likelihood of needing an emergency appointment rises significantly.
The difficulty of finding care if you or loved one is a patient with special needs
The LA Times article has this caveat:
There also is literature on dentists' unwillingness to treat certain populations, including young children, patients with developmental disabilities...(par 5)
While the focus in this study is on access to dental care, patients with special needs find it harder to find willing providers more often than their privately insured counterparts, according to a multitude of reports published by the journal Pediatrics (keywords "Medicaid" and "access to care") and other Medicaid reports put out by the Kaiser Family Foundation (KFF).
What does this mean in the real world?
While Medicaid provides care for an overwhelming one-third to fifty-nine percent of the nation's children, and a majority of those with special needs, lingering attitudes and very real Medicaid reimbursement concerns keep many providers from offering the same access to care that those with private insurance enjoy.
The LA Times article suggested some of the underlying reasons for this, data from Pediatrics shows that the issue is much more complex than whether or not the dentist or pediatrician around the corner wants to see more Medicaid-insured patients. Other factors play a role in denying that access to care.
Those in Washington already looking at cutting Medicaid should be considering the effects of this action, and before they cut one penny, they should be addressing the underlying proclivities of Medicaid to set reimbursement rates and effect policies that make it harder for physicians to want to comply with the program.
For those of us in the special needs community, the benefits can't be over-emphasized, but that benefit is tempered by the inability to receive the coverage needed.
A final thought, not all of the problems with Medicaid stem from problems with management. Overall public stigmatism is still high among those who aren't familiar with the program. Fighting this perception of being inherently flawed because of being on Medicaid will take more than studies or changes in Washington, it will require folks to talk, openly, about the program and the benefits (as well as the drawbacks).
Those of us in the special needs community, who require the coverage extended by Medicaid, need to be proactive in helping change public perception while at the same time fighting for our kids to receive the care they need while covered under Medicaid and related services.
Source: LA Times article
Chime in with your opinion: Do you or a loved one have Medicaid? How does information like this make you feel about your coverage?
If you or a loved one has special needs, have you ever been personally affected by perception or denied an appointment?
Katrina Moody is Kat, of Kat's Cafe: wife and mother, writer and editor, advocate and dreamer. She writes passionately about disability-related topics.
Her passions stem from the real experiences of being a mother to three amazing boys who all have a rare disorder called Rieger Syndrome. They also share diagnoses of autism, epilepsy, visual impairment, cerebral palsy, and more. Her Moody-gang is the inspiration for articles meant to raise awareness and understanding of the complicated world of special needs parenting.
Find her at Kat's Cafe: http://www.katscafe.org/
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