Getting toothaches is a routine part of life. Having to travel nearly 200 miles to seek treatment for a toothache is not routine, but it is a scenario many people, especially children, in the central Kenai Peninsula face due to a lack of dental care access for uninsured or underinsured people.
James Bounds of Kenai has experienced this problem with his daughter firsthand. Bounds' daughter is enrolled in the Medicaid program. When Bounds moved to Kenai two years ago, he found a dentist who accepted new Medicaid patents and was able to get his daughter an appointment and dental treatment.
However, the next time Bounds called the dentist to make a yearly check-up appointment for his daughter, he was informed the dentist no longer took Medicaid patients.
Since then, Bounds has been unable to find another dentist in the central peninsula who will.
"I either have to take her to Anchorage or take her to Homer," Bounds said. "That really creates a problem. ... There's nothing worse than a kid sitting in the house with a toothache, and they can't get in to see the dentist because they don't take Medicaid. There's something haywire here because of that."
Bounds and his daughter are not alone in this situation.
According to a community assessment done in 2000 by the state Division of Public Health and Healthy Communities-Healthy People on access to dental health care for children enrolled in Medicaid or Denali Kid Care in the central peninsula, there is a great unmet need for local oral health care for children and adults in low-income families.
The assessment found that since 1998, approximately one-third of the children from the central peninsula who were seen by a dentist traveled to Anchorage or Homer for their dental care because of the lack of local Medicaid dental providers. Low-income families who are unable to travel out of town simply did not get any dental care.
Pat Morrison, the public health nurse at the Kenai Public Health Facility, said she sees many children on Denali Kid Care in need of dental care through the health screenings the facility offers. She generally has to refer those patients to dentists in Anchorage because it is so difficult to find care locally, she said.
"They seem frustrated. Wouldn't you be?" she asked. "For most of us, if we want a dentist appointment it takes a while to get in, but most of these kids know they're not going to get in."
In July 1999, 2,835 of the estimated 11,002 central peninsula children and teens between the ages of birth and 20 were enrolled in Medicaid, the assessment stated. Only 528 of those children were found to have had a preventative dental visit in the preceding year.
The assessment concluded that the most significant barrier to gaining access to dental care for these people is the lack of local dentists who take new Medicaid patients.
In 1999, the assessment found, five general dentists out of 11 were enrolled as Medicaid providers. Four of those dentists provided care to 34 percent of the children who received Medicaid-funded dental care.
That means the majority -- 66 percent -- of the children who received Medicaid-funded dental care received it from an out-of-town dentist, from the itinerant pediatric dentist who travels to the central peninsula periodically or from tribal clinic dentists who only accept Native patients.
The findings of the assessment paint a bleak picture for central peninsula Medicaid recipients and uninsured people in need of dental care -- especially as the progressing winter makes travel to Homer or Anchorage increasingly more daunting and inconvenient.
But there is hope.
It comes in the form of two planned dental clinics that will provide services for underinsured and uninsured central peninsula residents.
One will be an expansion of the existing Dena'ina Health Clinic on Frontage Road in Kenai. The clinic plans to open a dental facility within the next few months in the same building the health clinic is in, said Barbara Norbeck, office manager at Dena'ina Health Clinic. The facility will have one full-time dentist, a part-time dental hygienist and support staff and room to expand to six operatory spaces.
The dental clinic will provide general dentistry to Alaska Natives and American Indians and is expected to treat 150 patients a month.
Another proposed clinic on the horizon is aiming to address the unmet dental needs of non-Native underinsured and uninsured central peninsula residents, including people on Medicaid and Denali Kid Care.
The proposed clinic would be operated by Central Peninsula Health Centers Inc., the same organization that runs Central Peninsula General Hospital and the Cottonwood Health Center.
It is planned to be in what was the Kenai Dental Clinic on Main Street Loop, have five dental chairs, one full-time dentist, a pediatric dentist two days a month, and possibly more staff members, depending on how much funding the clinic receives.
The proposed clinic has been in the works since last spring, but unresolved funding issues are proving to be the one main stumbling block to making the clinic a sure thing.
A federal grant was issued last spring to provide operation money for a dental clinic that would provide local service to underinsured and uninsured people in the central peninsula.
The money became available Sept. 1, and the grant stipulated the clinic must offer services within 120 days of Sept. 1, said Stan Steadman, executive director of Central Peninsula Health Centers.
The problem is, the grant only awarded money for operational costs, so clinic organizers were left to find another way to pay for a facility. The state, specifically the Division of Medical Assistance, offered to help out, through the Disproportionate Share Hospital Payment Program (DSH).
This program is run by Medicaid through the Health Care Financing Administration, and is designed to compensate medical facilities that serve a large number of Medicaid patients. It works through a long and complicated line of intergovernmental transfers and reimbursements that ends with the federal government ultimately footing the bill.
To get the process started, a local government must first provide a segment of the funding to the state through an intergovernmental transfer.
In the case of the proposed dental clinic, the sum of money needed is nearly $800,000.
In theory, the government would get its money back, plus an additional sum to fund the dental clinic. The problem is, this method of funding is unusual and not without financial risks.
It is possible that once the state reimburses the local government for the initial money and seeks reimbursement from the federal government, the federal government may decide not to pay. If that happens, the state could take back the money it reimbursed the local government with, thus leaving it to foot the bill.
The state first approached the Kenai Peninsula Borough for the money, which began to research the deal in-depth. The state later approached the city of Kenai with the same deal and found the city's administration had the same concerns the borough administration did.
"The state made the decision to request that the city of Kenai provide the (intergovernmental transfer) because there was a perception that the questions being raised by the borough was going to cause delays in the process that the state thought could be avoided," said Jeff Sinz, borough finance director.
"What they found was that the same questions the borough had were raised by the city of Kenai. So some of the perceived advantages the state had just didn't exist."
At this point, the state has once again approached the borough to provide the money, Sinz said.
This time, a possible solution has been found to mitigate the financial risk the borough would face. According to Steadman, if the deal is approved, the initial money the borough pays will be used to purchase a facility for the dental clinic, then the DSH grant money reimbursement will pay back the borough and the building will be put up for collateral in the deal, in case anything goes wrong.
The borough assembly will be presented with a resolution of general support of the dental clinic plan in its Dec. 10 meeting. If that resolution is passed, the assembly must later pass another resolution approving the intergovernmental transfer of nearly $800,000.
The Central Peninsula Health Centers board also must approve the project, as well as the state Legislature, when presented with the Division of Medical Assistant budget.
Steadman urges anyone who is in favor of the clinic to voice their support to borough assembly members, hospital board members and state legislators.
James Bounds said he definitely is in favor of having a dental clinic.
"That's a tragedy to me," he said. "We live in the United States of America, and we can't even get our kids' teeth worked on. That's sad."
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