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Releases & Statements
***FOR IMMEDIATE RELEASE*** March 25, 2009
Contact: Anat Gerstein
(212) 669-4743
Release #: 008-2009
PA Gotbaum: Report Finds City’s Plan to Shut Cost-Effective Dental Clinics Limits Options for 17,000 Vulnerable Kids
Only 12% of Medicaid Dentists and 6% of HHC Clinics Able to Provide Appointments within 24 Hours
Program Set to Close Would Cost City Only $147 per Student; $72 per Visit
Read Report
MANHATTAN – A new report released today by Public Advocate Betsy Gotbaum refutes the Department of Health and Mental Hygiene’s (DOHMH) stated reasons for shutting down the Oral Health Program (OHP), and calls on the city to continue to provide much-needed dental services to 17,000 New York City children in 41 school and community based dental clinics and five health center dental clinics.
Public Advocate Betsy Gotbaum said, “It makes little sense to cut a low-cost program that provides much-needed dental services for the most vulnerable children. My office found that it’s not easy getting dental services for Medicaid recipients or the uninsured. Furthermore, it’s important to have someone who understands how to treat a child. OHP dentists are experienced in treating children with disabilities, behavioral problems, and other health problems such as eating disorders and drug use. This program is part of our safety-net, and DOHMH must maintain it.”
Gotbaum’s report, “Touching a Nerve: How Closing the City’s Oral Health Program Reduces Access to Dental Care for New York City Children”, is based on surveys of 31 OHP dentists, 100 Medicaid Dentists, and 16 Health and Hospitals Corporation (HHC) dental clinics, as well as an analysis of city and state data. While the city claims that there will be accessible alternatives once OHP closes, the report finds that only 12 percent of Medicaid dentists surveyed could provide an appointment within the 24 hour timeframe required by New York State for urgent dental care; and nearly one out of every three HHC facilities had wait times of more than a month to three months for filling a cavity.
Councilmember David Weprin said, “This report clearly shows the importance of the program and the negative impact it would have to communities throughout the city if it were eliminated.”
Niokka Jackson, a mother of two children who have benefited from OHP, said, “When my oldest daughter was 5, I took her to a private dentist in the community—never again. They didn’t know how to treat children, and they didn’t numb her mouth properly. This program is a blessing because it is right there in the school and the care is excellent. I don’t have to worry about my children getting inadequate dental care. It would be tragic for Mayor Bloomberg to cut the program.”
Last year, children made more than 35,000 visits to OHP dentists. The program is scheduled to cost the city $2.5 million in Fiscal Year FY 2010. According to DOHMH, the program must be eliminated to fill the budget gap. They further claim that services offered by the clinics are available elsewhere and that OHP clinics have low productivity.
Findings of the report include:
-The OHP is cost-effective: average OHP per capita costs ($147) are half the nationwide average cost for Medicaid enrollees who received dental services ($305).
-The DOHMH could realize significant additional efficiencies by requiring parents to provide insurance information on parental consent forms. For each additional point by which the DOHMH increases the percentage of OHP visits billed to Medicaid, the DOHMH would save $17,591.74. If DOHMH were able to increase the Medicaid reimbursement rate by 30 percentage points, it would save an additional half million dollars ($527,752.22)
-Only one HHC dental clinic could provide an appointment for filling a cavity within 24 hours.
The Public Advocate recommends that the DOHMH take the following actions:
-Immediately reverse the decision to eliminate the OHP and keep the five operating dental clinics at health center sites and forty-one school- and community-based sites open.
-Make insurance information mandatory on parental consent forms to increase reimbursement for services rendered while continuing to provide care to children who are uninsured.
Additional findings include:
-The majority of OHP dentists report a far higher incidence of untreated cavities and other dental problems among school-based preventive care patients than the 14 percent referral rate cited by the DOHMH.
-The majority of OHP dentists report that new record-keeping requirements implemented as part of the reorganization of the program created large amount paperwork but that much of the information was not used in a timely manner, if at all.
-Nearly one out of every six Medicaid dentists surveyed (17 percent) either could not be reached using the most recent contact information or did not accept new Medicaid patients.
-The majority of Medicaid dentists available said that they were not specialized to treat children, even though the majority of Medicaid enrollees are under 20 years old.
-The elimination of the OHP could cost New York City children up to nearly three years in lost school days.
-There are nearly 40 percent fewer dentists available to new Medicaid patients in New York City than estimated by the DOHMH.
Recent History of OHP
Between 2003 and 2008, the DOHMH allowed the program to lose staff through attrition. In 2006, the DOHMH initiated a reduction and reorganization of OHP dental services, shifting the emphasis from treatment to preventive care. The new emphasis on prevention was implemented through the creation of ten mobile sealant sites, operating in elementary and middle schools beginning in September 2007. At the same time, the DOHMH closed a combined 31 school-based dental clinics in FY 08 and FY 09, more than half of which had been located in high schools or junior high schools, and instituted new protocols for referrals and record-keeping, which according to OHP dentists, increased paperwork so much that time for patient care was sharply reduced.
In FY 2007, prior to the reorganization, announced as an “improved service paradigm” that would “allow more children to access better services,” the OHP recorded 47,518 visits to school-based clinics, health center clinics, and summer clinics combined. In FY 2008, including visits to the sealant sites, the OHP recorded a combined 35,582 visits.
A three-year study of Medicaid reimbursement found that the cost to manage symptoms related to untreated tooth decay on an in-patient basis is approximately 10 times higher than the same care in a dental office.
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