
A Michigan Program Asks the Working Poor to Volunteer to Get Free Dental Care
More than 100 million adults don't have dental coverage, which is not an essential health benefit even though data show rising numbers of emergency department cases related to dental problems. A Michigan experiment shows a possible solution, but even the study's author said it is not a panacea.
The growing divide between
Even under the Affordable Care Act, dental coverage isn’t an
In Michigan, health officials in Ingham County came up with a solution: they offered a group of low-income adults $25 in dental services for every hour of volunteer work, during a program that ran from January 2014 to October 2015.
Called Pay It Forward, the program attracted 38 patients, including 27 who took part in a survey afterward. While 80% of the respondents liked the program and would do it again, about 12% said that juggling their volunteer hours with work and family responsibilities was a struggle. What drew them to the program? About 70% who signed said they were in pain, and 38% said their dental woes affected "all aspects" of their lives.
Lorene Kline, who surveyed both patients and providers for her master's thesis at the University of Michigan School of Dentistry, said in
"That made us question whether it's a good model for working adults who have families and children," said Kline. "It's probably more difficult for them to find the time to dedicate to community service."
The Michigan experiment could play out more broadly. Kentucky Governor Matt Bevin has asked CMS to change the terms of his state’s Medicaid program, so that adults who received coverage under Medicaid expansion would have to earn “rewards,” which could include
Groups like the American Dental Association argue that barriers to the dentist’s chair are short sighted, since trips to the emergency department (ED) tied to dental problems
A 2011 Delta Dental study that Kline cited found that 7000 visits to the ED could be prevented with better dental care, including 1000 visits that require hospitalization. Hospitals collected only about $15 million of the estimated $58 million cost.
Kline said the programs like Pay It Forward could help address unmet need for low-cost dental care, but they were not a panacea. The program covered adults who earned less than 250% of the federal poverty line but did not qualify for Medicaid. They could earn hours to cover basic cleanings, x-rays, extractions, and simple restorations; the program was not designed for major restorative work, although some dentists did provide more extensive procedures.
Overall, patients performed an average of 33 service hours and received more than $1150 in treatment. The total value of the treatment was $43,815. The value of the services varied, from $195 to $5056, Kline said.
Besides most patients being in pain, one-third said their teeth or gums limited what they could eat, and 40% said they were uncomfortable eating in front of others. Among the dentists, 7 of 9 who responded to the survey rated the program favorably on all aspects. Two said they didn't find volunteering rewarding and voiced issues with the volunteer activities, and said that the quality of care wasn't comprehensive enough.
The study was published recently in the Journal of the Michigan Dental Association.
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