Demand for care at state facility climbs as fewer dentists treat Medicaid patients
by Andy Marso, KHI News Service
A dental clinic at the Kansas Neurological Institute continues to serve Kansans who live outside the facility despite cutbacks two years ago. But it may need more funding if demand from non-residents increases.
The clinic’s top priority is serving 147 adults with intellectual and developmental disabilities who call KNI home.
But Brent Widick, superintendent of the Topeka facility, said KNI also has provided dental services for 71 non-residents with similar disabilities so far this year.
“It’s really kind of part of our way of trying to keep people in their home; keep supporting them wherever they’re at,” Widick said. “We’re part of the whole continuum of services for anybody with disabilities in Kansas, and this is just our way of contributing. But this particular need is really (strong) out there. Dental services are just not as available.”
KNI and Parsons State Hospital and Training Center — the state’s other facility for Kansans with intellectual and developmental disabilities — both contract with local dentists to provide on-site care one day per week.
Both also allow non-residents with disabilities to access services on those days — an important resource for caregivers who struggle to find dental services for their Medicaid clients.
KNI employed a full-time dentist until about two years ago. The clinic’s staff was cut following an audit of state hospitals by an external consulting agency called the Buckley Group that recommended a host of cost reductions.
The consultants reported that the dental clinic did about 1,000 procedures for KNI residents and another 198 for non-residents the year before the cuts. They recommended that the KNI dental clinic cut its hours by 50 percent or start charging for non-resident visits.
Based on the Buckley Group’s report, the Legislature approved overall budget cuts to the state hospitals. KNI leaders and Kansas Department for Aging and Disability Services officials discussed how to implement the budget cuts, and reducing the dental clinic’s operations to one day a week was one of the outcomes.
Widick and Mary Gingrich, KNI director of health care services, said the clinic continues to provide high-quality dental care to residents thanks to the efficiency of the contracted dentist, Greg Cohen, and other medical staff.
But they aren’t sure just how many more non-resident visits KNI can handle — or how much demand there is outside the facility for the clinic’s dental services.
Overall dental shortage
Kansas has been grappling with a shortage of dentists in many areas of the state for years.
Kansans on Medicaid find it particularly challenging to get care because most dentists think the public health care program’s low reimbursements are not worth the paperwork involved. Kansas Medicaid pays about 40 cents on the dollar compared to private dental insurance, and the reimbursements were cut another 4 percent this year.
Gingrich said Kansans on Medicaid who have intellectual or developmental disabilities present yet another challenge for dentists because they are more likely to be uncooperative in the dental chair. So she’s glad to have the services of Cohen, a Topeka dentist who works every Friday at KNI.
“(Compared to) anyone without a developmental or intellectual disability who had that anxiety to go and see the dentist it’s multiplied, because not only do these guys have anxiety, but then somebody is forcing things to happen in their mouth that they don’t get,” Gingrich said. “Dr. Cohen handles it really well. He’s very patient.”
Cohen’s son works in a Prairie Village dental clinic that is one of the few providers in the state that take Medicaid patients with special needs.
Widick said Cohen could earn more taking private insurance clients on Fridays, rather than working under his KNI contract.
“It’s not competitive,” Widick said. “But it takes a decent person who wants to step in and do that.”
For his part, Cohen said he’s at the point in his career where he has some flexibility and he enjoys working with the developmental disability community.
“I feel good about the service I provide here,” he said. “These folks need it here.”
Hitting a ceiling
But people with disabilities living outside of KNI increasingly need it too. Widick said the number of non-residents coming in for dental care seems to be increasing, while KNI’s budget is not.
So far, Widick’s facility has been able to take all comers. But there’s a ceiling to that.
“Our focus will always have to be the people living here,” Widick said. “I’d hate to get to the point where we’d have to start saying no. But again, we can only do what we can do that doesn’t cost the state more.”
Cohen said he does an average of eight appointments a week at KNI, or roughly 400 per year.
Every KNI resident is seen at least twice a year, leaving about 100 appointments remaining for non-residents and follow-up care for residents who need extra attention.
Gingrich said she is worried the clinic won’t always be able to meet the demand from people outside KNI because she doesn’t know the number of people who might come seeking care.
“The more people that needed it, we’d have to almost add another dental day, so funding concerns me,” Gingrich said. “Getting more of Dr. Cohen’s time (and) those resources that are so valuable.”
Angela de Rocha, a KDADS spokeswoman, said the agency could request that the Legislature appropriate more money for KNI if needed.
“Of course the hours of the dentist could be adjusted if the demand starts to outstrip the availability of his time,” de Rocha said.
However, reduced state revenues that followed income tax cuts approved in 2012 have created budget challenges for legislators in recent years.
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