June 2001 (Vol. 2, No. 8)
Dental Care Access In Wisconsin
By Rodney Moen, Senator WI State Legislature, David West, Representative, WI State Legislature, Laura Rose, Deputy Director, WI Legislative Council

Wisconsin currently experiences a significant problem with access to dental care services for its residents. Contributing to this problem is a shortage of dentists. The Wisconsin Dental Association, a statewide trade association of dentists, recently commissioned a study on the dental workforce shortage that shows that, between the years 2001 and 2010, Wisconsin will experience a net loss of 297 dentists, which represents approximately 10 percent of the current workforce of 2,979. (Wisconsin Dental Association Summary of Wisconsin Dental Workforce Report prepared by Tryfon Beazoglou, Ph.D., Howard Bailit, D.M.D., Ph.D., and Dennis Heffley, Ph.D., University of Connecticut Health Center, January 2001).

Nationally, the ratio of dentists to the total population is also declining. According to the Surgeon General’s Report on Oral Health in America, published in May of 2000, there were approximately 58.4 professionally active dentists per 100,000 people in the United States in 1996, down from 59.1 in 1990. By 2020, the dentist to population ratio is expected to drop to 53.7 per 100,000. In addition, the absolute number of active dentists will decline after 2000, due to retirements of dentists, with insufficient numbers of new dental school graduates to replace them. Applicants to dental schools declined by 4% in 1998, with further declines of 8 to 10% expected for 1999 and 2000.

Although the shortage of dentists affects everyone, low-income populations, such as those receiving Medical Assistance (MA) and BadgerCare, face a greater problem than other populations with regard to access to dental services. Data from the Wisconsin MA program shows that 57.6% of licensed Wisconsin dentists were MA-certified as of June, 2000. Of this number, 42.3% of certified dentists submitted claims to the MA program in state fiscal year 2000. For that same year, only 22% of Wisconsin’s MA population received any dental services. These access rates are significantly lower than those of the general population. The Surgeon General’s report cites studies estimating 43% to 65% of the United States population visiting a dentist each year. Survey estimates vary depending on the question and survey method used.

Dental access problems for persons of low income are not confined to Wisconsin. The Surgeon General’s Report cited a 1996 report by the U.S. Department of Health and Human Services Office of Inspector General that estimated that 80.3 % of infants, children and youth who are eligible for Medicaid do not receive preventive dental services. It is difficult for Medicaid recipients to find dentists who will take them as patients. One reason for low participation by dentists in the Medicaid program is the low reimbursement rate for dental services provided by states, which averages 47% of usual and customary fees.

The Wisconsin legislature responded to the dental access problem by establishing the Joint Legislative Council’s Special Committee on Dental Care Access in the summer of 2000. The Special Committee, which consisted of 3 Senators, 5 Representatives, and 13 public members, met 7 times in the state capitol between September 2000 and February 2001. The Committee developed two pieces of legislation, which have been introduced into the 2001 Wisconsin legislature as 2001 Senate Bills 166 and 167, and Assembly Bills 366 and 367. To address issues related to the supply of dental personnel, the legislation recommends the following:

The Committee reviewed the low participation rate among licensed Wisconsin dentists in the Medicaid program. Concerns were raised by dentists regarding the inadequacy of Medicaid reimbursement and the burdensome administrative requirements imposed by Medicaid. To address administrative concerns, the DHFS established a working group that is making progress on these issues. In addition, the Committee recommends the following items with regard to the Medicaid program:

The Committee also made recommendations to improve service delivery of services to patients, including preventive and educational services. These items include:

As of the date of this brief, the Senate Bills have been reported out of the Senate Committee on Health, Utilities and Veterans and Military Affairs, and await action by the Assembly Health Committee. Consideration of this legislation should result in significant discussion of the issue of dental access in Wisconsin by policymakers this legislative session, and increased awareness of this problem throughout the state.