Foster children struggle to get dental care

Thursday, Dec. 4, 1997 | 9:59 a.m.

Don't mention dentists to Las Vegas foster mother Deanne Blazzard.

A 9-year-old boy she adopted went without dental care from age 3 to 8, even though he had Medicaid as a foster child.

"There are no providers here in Las Vegas," she complains. "There was a dentist who would do 2- and 3-year-olds and one who would do children 8 and over, and that's it. So what would you do in between?"

Many local foster children go without dental care because there aren't enough dentists who take Medicaid patients. It's not that dentists don't like foster children. Many are just not fond of other Medicaid clients, namely adult welfare recipients.

Drs. Patrick Simone and James Kinard are among a small number of Las Vegas dentists who treat foster children. Like many of their colleagues, however, they don't approve of the way the state has run the Medicaid program.

"A lot of providers don't want to have a lot to do with it because of the bureaucracy," Simone says. "The (adult) patients are also a problem because they don't show up for appointments and they're arrogant."

Many dentists don't sign up for Medicaid because they're under the impression that they'd have to accept the welfare adults as well as the foster children. But April Townley, deputy administrator of the state's Division of Health Care Financing and Policy, says dentists can choose which Medicaid clients to serve.

"A dentist can choose to serve only foster children," Townley says. "There's nothing preventing that. There's nothing in the (state) contract that says once you sign you have to take Medicaid (recipients)."

Even so, Kinard says several dentists dropped out of the Medicaid program because the state failed to increase reimbursements and make other changes in a timely manner.

"The state promised there would be a fee schedule change in April 1996 but it didn't take effect until this summer because of red tape," Kinard says. "One of the other things a lot of doctors had a problem with was the no-show rate was excessively high. If you reserve time for a patient and they don't show, that costs you money."

Townley says changes that became effective May 1 are already luring more dentists into the Medicaid program. The state raised its reimbursement rates, though they still don't cover all provider costs. Paperwork also was streamlined.

As a result, the number of Clark County dentists enrolled in Medicaid rose from seven to 19. That's still a small percentage of the estimated 400 dentists in the county.

Townley concedes dentists are right to complain about the patient no-shows. The state has attempted to address that by encouraging welfare recipients at orientation sessions to show up for their dental appointments.

"If each dentist would take three or four welfare clients, it would be a great help to this program," Townley says.

Instead of going through Medicaid, Simone has served more than 100 foster children free of charge. He began doing so at the urging of one of his patients, Donna Husted. She happens to be president of the fund-raising arm of the county's Court-Appointed Special Advocate program for foster children.

"The kids are very thankful for their care and they keep their appointments," Simone says.

Most of the foster children Simone has treated didn't have prior dental work. Many had grossly decayed teeth and multiple abcesses.

"Most of these kids live with toothaches on a day-to-day basis thinking it's part of their existence," he says. "A lot of the kids I've seen have now been restored so they're in a stable situation. We want to see new kids now to get them out of an acute situation."

Simone estimates that 40 percent of all local dentists provide free care to various segments of the indigent population. The problem is there's no central listing of these providers, something Simone and Kinard are seeking to change.

"There are a lot of dentists providing (free) care but nobody knows what the other guy is doing," Simone says. "For instance, I don't know who is doing braces for these children. Someone else might know someone who is doing braces but doesn't know anyone who does root canals."

The lack of such a clearinghouse is one reason Blazzard has had problems finding dentists for her foster children. Recognizing this as a problem, Townley says her office soon plans to send foster parents a list of all Medicaid providers in the county.

Simone, for one, believes more dentists would sign up for Medicaid if they are assured they would be able to treat only foster children.