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Dental patients are plagued by a growing shortage of Medicaid providers in rural Iowa

A large room in an auditorium is filled with people wearing blue surgical gowns and people laying on chairs getting dental work done.
Iowa Dental Foundation
A team of dental providers volunteered at Iowa's Mission of Mercy, a large-scale, free dental clinic at Sioux City's Tyson Events Center in early October. Hundreds of patients received free treatment over two days, highlighting the need for more Medicaid providers in rural parts of the state.

Officials with the Iowa Dental Association want state lawmakers to address a major shortage of dentists who accept Medicaid patients. Health officials in northwest Iowa say children and the poor are especially impacted.

Buena Vista County Public Health Resource Specialist Tracy Gotto said many young people in his community face critical dental issues.

“We know that it affects their ability to learn and eat,” Gotto said. “We know that it affects all kinds of health issues regarding a child's body, but we also know that we have adults in our community that need dental care and the amount is overwhelming.”

Of the five dentists who serve Storm Lake, no one accepts Medicaid patients. The only available provider is the local health center.

“Dentists are just saying that they can't do it based on the reimbursement, and I think we're just having this crisis all over. We were sending kids to Fort Dodge at one point, and now Fort Dodge is saying they can't take any more kids either,” Gotto said.

A man is wearing a black button-down shirt and beige slacks. He's smiling and sitting on the right side of a desk with a computer in front of him.
Buena Vista County Health Department
Tracy Gotto was a social worker for about 30 years before joining the Buena Vista County Public Health Department this year. Improving dental care is one of his top priorities.

The Webster County Health Department, where Fort Dodge is located, operates the I-Smile program for children aged zero to 21 in a seven-county area to improve oral health. An I-Smile Silver program covers adults.

“This issue is not new — however, as more children are denied access to dental care, the overall health of our population will deteriorate, leading to increased healthcare costs that will continue to pose a significant burden,” I-Smile Oral Health Coordinator Cindy Partlow said.

The Fort Dodge Community Health Center addresses dental emergencies, but cannot provide comprehensive dental care for adults or take on new patients over 18.

“As a result, many adult patients need to travel outside of the county to receive dental care,” said Amber Cooke, I-Smile Silver Coordinator. “Most referrals are over an hour one-way, and traveling across the state is not always feasible for care facility residents, individuals with debilitating conditions, elderly or full-time working individuals who depend on employment hours — and their dental care usually requires multiple trips.”

Buena Vista County also sends children 120 miles away for care at Creighton University in Omaha or even double the distance to Iowa City.

Identifying the issues

The President of the Iowa Dental Association, Chris Bogue, wants his organization to push state lawmakers to address the underlying issues creating the shortage of providers. It's an agenda they have tried to get passed for the past decade without any luck.

A headshot of a man who is smiling and wearing a blue button-down shirt.
Carroll Dental Clinic
Chris Bogue, an Ogden native, is the president of the Iowa Dental Association and part-owner of the Carroll Dental Clinic.

“The reimbursement rate is one, and the secondary problem is that we don't have the staff to help us see many of these patients. We have a double whammy, and both of those issues are our legislative priorities this year,” Bogue said. “If you look at the [contiguous] states around us, they’ve all raised their rates, including Missouri, which helps tremendously."

Low Medicaid reimbursement rates

Bogue, a dentist in Carroll, said reimbursement rates stayed stagnant for almost 20 years, and dentists lose money on each Medicaid patient they see.

“Inflation has gone up 66% since the last meaningful increase,” Bogue said. “It is hard, and that's the struggle. As dentists, we want to do everything we can to help — but we're getting paid 20 to 30 cents on the dollar. And that doesn't even cover overhead for a lot of the cases."

The Iowa Dental Association reported the average cost of routine cleaning for an adult is $75.29 — not including other costs, such as employee benefits or payroll taxes. Medicaid only reimburses $35.82, resulting in a net loss of at least $39.00. Officials over time say many dentists are forced to limit or stop the number of Medicaid patients they treat.

A recent survey by the nonprofit also found that 40% of dentists are actively recruiting dental assistants, with a slightly lower percentage looking for hygienists. Overall staffing shortages caused an estimated 11% drop in dental treatment capacity.

“We just had a hygienist that left — we advertised for the position — but nobody was interested,” Bogue said. "We may have to get rid of Medicaid because we don't have the providers to help us."

Free clinics try to fill the need

Iowa academic health clinics and community health centers, especially in northwest Iowa, also treat a tremendous backlog, with many facing more severe conditions because of infrequent dental checkups.

A recent free, large-scale dental clinic in Sioux City organized by the Iowa Dental Foundation quickly reached capacity. Organizers turned away 1,000 people desperate for coverage after exhausting all other options.

“We continue to work with Iowa Medicaid, other stakeholders and legislators to explore solutions to both the Medicaid and workforce issues so that every Iowan, no matter where they’re located or their ability to pay, can have access to the highest quality of dental care,” said Laurie Traetow, executive director of the Iowa Dental Association and Foundation.

Buena Vista County saw 105 patients in the emergency room last year for dental issues alone. To try to address the root of the problem, health officials launched an oral health coalition of several community members and state representatives. They conducted a survey to explore the way young people drink.

“We found that 80% consume only bottled water. People in Storm Lake come from all over the world, including a huge influx of Pacific Islanders, and they only drink bottled water instead of tap water, which has fluoride — which helps keep teeth strong,” Gotto said.

Gotto said Delta Dental stepped in to treat 44 children before Thanksgiving with a free clinic, but since some still need service, another is scheduled for this month.

“They have been excellent to work with,” Gotto said. “But we think we’ll also overwhelm that clinic because the needs here are so large.”

Sheila Brummer is IPR's Western Iowa Reporter, with expertise in reporting on immigrant and indigenous communities, agriculture, the environment and weather in order to help Iowans better understand their communities and the state. She's covered flooding in western Iowa, immigrants and refugees settling in Iowa, and scientific partnerships monitoring wildlife populations, among many more stories, for IPR, NPR and other media organizations. Brummer is a graduate of Buena Vista University.