By Tom St. Myer
When it comes to dental health, Florida has the dubious distinction of ranking among the worst states in the nation.
WalletHub released a report in February that ranked Florida 42nd out of 50 states and the District of Columbia in dental health. The personal finance company used 25 metrics, ranging from the number of children who visited a dentist in the past year to dental treatment costs to dentists per capita.
Community Health Chief Dental Officer Gabriel Hernandez partially attributes the No. 42 ranking to the few dental providers in Florida accepting Medicaid. Only 22% of dentists in the state are enrolled as Medicaid providers, according to a survey conducted by the Florida Department of Health.
The Medicaid Problem
The Community Health dental care team is one of the few in Northwest Florida that accepts Medicaid for both children and adults. That means few dental care provider options for low-income families, which there is no shortage of in Escambia County. About 27% of the county population is on Medicaid, according to FLHealthCHARTS.
Inadequate reimbursement rate is the reason why so few dentists accept Medicaid. Take children for example. Nationally, Medicaid reimbursement accounts for 61.4% of private insurance reimbursement for child dental services, but Florida falls far below that average at 42.6%.
The Community Health dental care team is a prime example of what happens to the few providers who accept Medicaid. The team is stretched thin between its on-site locations and two mobile units.
“There’s more need than we’re able to manage,” said Chandra Smiley, the Community Health CEO and executive director. “We’re pretty much capped out by our facilities. We would need to open up many more dental clinics to meet the need.”
Florida ranks 42nd in the percentage of adults who visited a dentist in the past year and 49th in the percentage of adults with poor or fair oral condition, according to the WalletHub report. Results are similar for children. Florida ranks 44th in percentage of children who visited a dentist in the past year.
The percentage of children visiting a dentist is particularly low among those growing up in low-income families. Keenly aware that exorbitant costs and transportation issues deter low-income parents from taking their children to the dentist, Community Health brings dental care to the children with its mobile units.
Mobile Units’ Impact
The Community Health dental staff travels to Escambia County Public Schools and Head Start locations four times a week to examine children, clean their teeth and, in some cases, apply sealants. The staff mixes in education by sharing tips on best practices for dental health.
“Parents don’t bring them into dental appointments until it’s too late,” Hernandez said. “We’re catching them earlier at schools. We’re proactive vs. reactive. If they’re already in pain, it’s too late.”
In January alone, the staff examined 238 children and completed 223 cleanings with the mobile units. C.A. Weis Elementary and Global Learning Academy top the schools in students receiving dental care. Its dental care extends beyond preschool and elementary school students. The staff uses the mobile units to examine and treat middle and high school students throughout the county.
Operating two mobile units costs a pretty penny. Costs include purchasing vans, maintenance, equipment, insurance and staffing. A grant awarded to Community Health from Escambia Children’s Trust eased some of the financial burden. Awarded in October 2022, the grant covered $76,673 in expenses.
Smiley said budget constraints prevent the dental care team from expanding its mobile unit services outside Escambia. Community Health envisions someday operating a third mobile unit for children in Santa Rosa County if the funding materializes.
Smiley is closely monitoring House Bill 1173 and Senate Bill 1254. HB 1173 has already passed two of three Florida House committees and is awaiting the first Senate committee.
Brought forth by Floridians for Dental Access, American Children’s Campaign and Florida Dental Hygienists’ Association, the bill authorizes Medicaid to reimburse for dental services provided by certain mobile units. The bill further authorizes the licensing of dental therapists to increase dental access and improve the overall dental health of Floridians. Dental therapists offer a more comprehensive range of care than hygienists, including checkups and fillings.
Smiley said this is the fifth year the bill came before the State Legislature, but this marks the first time the bill passed two committees. She is unsure the bill will pass this legislative session, but she is optimistic the bill is gaining momentum and will be signed into law by next year.
Florida leads the nation with nearly 6 million individuals in dental health professional shortage areas. Escambia County qualifies as a dental desert. The county scores 23 out of a worst-case 25 in dental health professional shortage areas. So, in other words, Escambia ranks as one of the worst counties for finding dental care in one of the worst states for dental health.
Dental health issues cause individuals to live in pain, miss work or school, or visit the emergency room for preventable dental conditions. Florida hospitals billed more than $550 million in 2021 for emergency room and hospital admissions related to non-traumatic dental conditions, according to America’s Children Campaign.
“Florida spends more on treating the consequences of poor oral health than any other state in the nation and has the least to show for it,” said Dr. Frank Catalanotto, president of Floridians for Dental Access. “Hospitals are the most expensive and least equipped place to treat preventable dental conditions. All they can do is provide temporary pain relief. The pain returns when the antibiotics wear off. And Florida taxpayers are largely picking up the tab.”
So why is there a shortage of dentists in Florida? Hernandez said stringent licensure requirements stop dentists and hygienists with licenses in other states from moving to Florida. Each state determines its dental licensing requirements, and Florida puts strict measures in place to prevent seasonal dentists.
“A Florida license is highly coveted and very hard to get,” Hernandez said. “The state of Florida doesn’t make it easy for dentists coming out of state.”
Nothing about Florida is seemingly easy when it comes to dental care.
