“Medicaid providers only make 45 percent on the dollar of what they would make otherwise, and a lot of people don’t realize that that number hasn’t changed since 2004."

An apple a day will keep the doctor away, but something else is keeping dentists from serving communities — Medicaid reimbursements.

These reimbursements have lagged behind the actual cost of providing care for years and worsened after the state’s emergency budget-balancing measures, which cut Medicaid reimbursements by 4 percent, or $38.2 million.

“Medicaid providers only make 45 percent on the dollar of what they would make otherwise, and a lot of people don’t realize that that number hasn’t changed since 2004. Then last year, they subtracted 4 percent and now we make nearly 40 percent on the dollar. The reimbursement’s horrible,” explained Troy Wiens, a dentist in McPherson who has provided Medicaid services since 1990.

These low reimbursements make providing Medicaid care less attractive in a number of medical fields, but rural providers are seeing an increase in patient load when their peers stop providing Medicaid services.

The Legislature is preparing to reconvene Jan. 9, but Gov. Sam Brownback and lawmakers have a few ideas for restoring the 4 percent cut amid larger budget problems. In the meantime, medical providers weigh the decision to continue serving Medicaid patients, many of whom already drive from rural areas to find care.

Wiens is not in this middle ground because he hopes to have a positive impact on this growing population in McPherson County.

“I decided a long time ago that the children in the Medicaid system cannot help the situation that they’re in. By having those services, they have a healthier lifestyle, and if I wasn’t here to provide those services for them, that wouldn’t happen,” Wiens explained. “People who think that poverty is not a problem in our county are terribly mistaken. We are blessed that we have a lot of industry that pays nice wages, but we also have a lot of people living at or below the Federal Poverty Line.”

Medicaid and Children’s Health Insurance Program, or CHIP, programs are required to offer children’s dental benefits, but coverage of adult dental services is optional for state Medicaid programs, reports the National Academy for State Health Policy.

Four states offer no dental program; 15 offer an emergency-only plan; 17, which includes Kansas, offer limited benefits; and 15 offer extensive benefits.

“We see those children through their growing years and they age out of the system. There are some limited provisions for adult dental care, but only for teeth cleaning or extracting a tooth, so there’s no provisions for major dental care,” Wiens said. “I don’t feel hopeful that the Legislature will reintroduce the issue because the state is so short on money. We have a governor who only wants to put money in his friends’ pockets rather than taking care of the residents of Kansas. The dentists who provide Medicaid are a very small group, so we don’t have much power in Topeka.”

Though CHIP covers Kansas’ youngest residents, it doesn’t address a major root of the problem — poverty.

“Dental care for children sets the stage for their whole lives. Without it, those primary teeth can be damaged, and that increases the risk of having unhealthy permanent teeth,” Wiens said. “You have to realize that a lot of people living in this poverty situation do not have the best diets and don’t receive fluoride in their diets. A lot of these kids live in a lifestyle where mom and dad’s biggest concern is where they’re next meal will come from, not getting to the dentist.”

Wiens explained that families in poverty have more stressors at work, so even something as simple as driving to the dentist can become a massive challenge.

“Their lives operate around getting to work, school and putting food on the table, not dental care,” Wiens said. “Several may miss an appointment or show up late, but we think that the dental care is more important than chastising them for not making an appointment on time.”

Though coverage is scant, providers are also few and far between. Wiens is one of three dentists accepting Medicaid and CHIP patients in McPherson County. In Western Kansas, numbers are even lower.

Melinda Miner, a dentist from Hays, contacted dentists throughout the region and compiled a map showing more than 20 western counties without a single dentist who accepts Medicaid.

Wiens started offering services to Medicaid patients to get his practice off the ground, but new dentists may not have that option.

A young dentist just starting work, with over $100,000 in student debt, would not be able to write off the losses from lower reimbursement rates, so few dentists are replacing those retiring.

“Without access to medicaid dental services, these children will go untreated,” Wiens said. “Personally, I think the problem lies in the low reimbursements. I know other dentists who would be happy to do it, but they don’t want to take time out of their schedule to work for at cost or less. It isn’t fair to the dental community and residents of Kansas to have it so low.”