04/03/11 — County Health Department dental clinic changes fee schedule

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County Health Department dental clinic changes fee schedule

By Phyllis Moore
Published in News on April 3, 2011 1:50 AM

Effective May 1, all dental patients at the Health Department will be charged based on Medicaid rates.

The Board of Health recently approved the change, creating the same fees for insured and uninsured patients and eliminating the sliding fee scale.

The move was prompted in large part by funding, or lack thereof, officials said.

"We don't get any money from the state, from the federal government, from the county commissioners. The only money that we get is money that we earn," Health Director James Roosen said. "Of course, we do get federal and state from Medicaid, but less than 50 percent of our Medicaid kids actually see a dentist and when they get to school they have got decay, abscesses.

"The last time I looked there were over 400 kids identified by school nurses or by the dental hygienist hired by the state, where these kids needed access to care."

The department's main goal is to stay afloat during an especially tenuous time economically, Roosen said.

"No telling what's going to happen with the state budget," he said.

The Medicaid cost settlement at the end of each year is usually sufficient for the health department to break even, said Ken Stern, administrative officer of finances.

"The state takes a look at what our actual costs were to provide the Medicaid services during the year," he explained. "The difference between our costs and what was reimbursed by Medicaid is settled up."

Like many other agencies and state offices, the state's current budget shortfall has left many pondering where cuts will be made.

"Some of the monies that county health departments are given to stay in business, and that's the chunk of change that we get in general aid to the county, that's probably going to be cut as they attempt to find the $2.6 billion or whatever it is," Roosen said. "But everything's changing, so I haven't really shared anything with the staff."

"In our dental clinic, we're seeing more and more uninsured," Stern added. "We're trying to keep a payer mix of 90 percent insured and 10 percent uninsured. ... But we're seeing less and less Medicaid and more and more uninsured, causing our deficit."

Some of the patients visiting the dental clinic have been comfortable with the sliding fee scale, especially those who had to pay out of pocket.

By lining up fees with Medicaid rates, hopefully it will enable the dental clinic to afford to see more uninsured patients.

"With our old fee schedule, we had a lot of folks paying at a minimum of 40 percent, on the sliding scale of what our fees were," Stern said. "With all of our patients now paying the full amount, those that were paying the 40 percent will be paying the full fee."

"That's going to make it free in terms of out of pocket for some people," Roosen added.

The idea to change the fees has actually been a long time coming, the officials said.

"Out of the last eight months, we have lost money five out of the last eight months and right now," Roosen said.

"We're about $38,142 in the red this year," Stern said. "It's not a recent thing. I have been tracking the stats on the dental clinic since I have been here the last five years. For every dime that we spent in a month that we didn't earn that money, we're taking basically out of our savings and that dwindles over time."

The Medicaid cost settlement could solve some of the deficiencies, Roosen said, but with the precarious state budget, nothing is guaranteed over the next two years.

The health department has already made its own internal cuts, Stern said. A dental hygienist position, for example, is currently vacant and might not be filled for some time.

"We may be able to offer more services and increase revenue, but if we don't have the money in the bank to support that position, we really don't want to bring somebody on," he said.

"We're just trying to stay in place from a public health standpoint where we can see everybody that otherwise wouldn't be seen by a dentist and we really need to focus on kids, that's really important," Roosen said.