Bismarck Tribune

By TONY SPILDEBy TONY SPILDE

The dental gap in Bismarck is a million dollars wide.

And, like plaque, dentists fear it will spread if it doesn't receive proper attention.

In the same month that a nonprofit dental clinic in town surpassed the $1 million mark in donated care, the state Legislature is considering two bills that could entice more North Dakota dentists to provide services for Medicaid patients.

Both attempt to appeal to dentists' wallets, but in different ways. One bill would increase the amount of money dentists get back for treating Medicaid patients. The other would require some dentists to treat more Medicaid patients if they want to take advantage of a student loan repayment program.

Bridging the Dental Gap, the public health clinic on south 12th Street, announced this month that it has given away $1 million worth of dental care in its 21/2 years of existence. In about the same amount of time, other dentists in town have donated a combined $250,000 in care, according to the North Dakota Dental Association.

Bridging the Dental Gap's full-time dentist, Joanne Luger, estimated that about 5 percent of Bismarck-Mandan dentists treat about 95 percent of Medicaid patients. Luger is privy to the numbers - she's the state's dental consultant for Medicaid.

While she has long decried the lack of care for low-income patients, Luger is not shouting in a vacuum. The dental association has pushed a pair of bills through the halfway point of this legislative session whose effects could be increased access for the underserved.

One, which passed the House, would set aside $3 million to reimburse dentists who treat Medicaid patients. The bill would establish a fee schedule so dentists know how much they will be reimbursed. As it stands, that fixed rate would be 85 percent of billed services, based on calendar year 2005. A little more than $1 million of the appropriation would come from the state's general fund; the rest would be a federal-Medicaid match. The new reimbursement schedule would expire June 30, 2009, or when the money runs out.

Currently, dentists are receiving about a 56 percent reimbursement on billed charges, according to the Department of Human Services.

In the new model, those billed charges would be averaged among all dentists who have been reimbursed through Medicaid.

Dentists would then be reimbursed at 85 percent of the average.

Joe Cichy, executive director of the dental association, said before the session that the 85 percent reimbursement rate has been shown to dramatically increase dentists' Medicaid participation nationwide.

"We've made progress,"Cichy said Tuesday. "We're not done yet. It's a step in the right direction."

A separate bill, which has earned Senate approval, would require some dentists to treat Medicaid patients if they want to use a state program that helps them pay down their student loans. That loan repayment - up to $20,000 a year for up to four years - has been used as a tool to attract dentists to rural communities and clinics that offer reduced-fee services.

If the bill passes as is, dentists would have to provide at least $12,000 in services to Medicaid patients each year.

"This fine-tunes the loan repayment program, the purpose of which is to get dentists to practice in underserved rural areas,"Cichy said. "Now this also helps with Medicaid."

Exempt from that law would be dentists who practice at public health clinics or nonprofit dental clinics like Bridging the Dental Gap, which uses a sliding fee schedule to bill its patients.

Without being able dangle the carrot of loan repayment, nonprofit clinics couldn't afford to hire new dentists.

"With us, we can't offer as attractive a salary package (as private practices)," Marcia Olson, executive director of Bridging the Dental Gap, said. "But when you tack on the ability to have loan repayment made through the state program, then it becomes more attractive."

Olson said she just hired a new full-time dentist, Steve Midstokke, a Bismarck native who graduated last year from Creighton University in Nebraska.

Being able to offer the loan repayment incentive was critical, Olson said.

Being excepted from that possible law was particularly important, because the bill would also disallow any dentist in Fargo, Bismarck and Grand Forks from using the state's loan-repayment program.

Cichy said those cities don't need to offer that incentive to attract new dentists.

The House bill is 1246. The Senate bill is 2152.