• 9 Investigates pediatric dental failure


    ORLANDO, Fla. - Almost half of Florida's counties have no pediatric dentist that accepts Medicaid, and critics said the situation is only getting worse.

    Starting June 30, in an effort to save money, the state began transitioning children off of the Medicaid system to a pair of managed care companies, MCNA Dental and DentaQuest.

    Many dentists said the regulations put in place by the companies, including prior authorization for any treatment, make the system cumbersome and costly. As a result, many of the pediatric dentists in central Florida who had been accepting Medicaid have either stopped accepting new Medicaid patients or stopped accepting Medicaid altogether.

    Under the managed plan, families can only see dentists in the network, and dental offices are paid a specific, set amount for each child -- a practice some say is designed to save money by limiting care.

    "There's limited places that you can take the children to, and oftentimes that might not have been your first choice," said Anna Brown, a Seminole County foster parent.

    In the past six years, Brown has fostered six children. All children in the foster care system are eligible for Medicaid benefits, including dental, however, foster parents said even finding a dentist to perform routine services is difficult.

    "These [are] things I can get [for] my biological child just like that," said Brown. "But I can't do the same for these kids."

    9 Investigates pediatric dental failure

    According to a study by the Pew Charitable Trusts, Florida has an F rating when it comes to pediatric dental care, with only 25.7 percent of children on Medicaid receiving dental care.

    In 2012, the state of Florida spent $22 billion on Medicaid, with only $202 million going to dental services.

    "We've been successful in a couple of instances in a dentist office that is willing to do some pro bono or volunteer work to help but is reluctant to get into the rest of the Medicaid system," said Glen Casel, president of Community Based Care of Central Florida, a service agency that help children transition out of foster care and into permanent homes.

    Casel and his group have set up several free clinics, often providing access to care that, for some kids, would be otherwise unavailable. The challenge, he said, is to get foster parents to be resilient and continue searching for care.

    But parents Like Anna Brown said even when a dentist is found that will accept a new child, the waiting list is often long, and it is not uncommon for appointments to be canceled with little to no notice.

    "If you try calling around and see who takes Medicaid, not all dentists' office take Medicaid," said Brown. "There's been a few times when we've had an appointment, gotten there, waited an hour and had the appointment canceled."

    As part of its investigation, Channel 9 contacted 20 central Florida pediatric dental offices at random. Of the 20 surveyed, only one said it was accepting Medicaid, and it would not say if it was accepting new patients.

    “Not receiving regular dental care makes kids very prone to infection from a cavity and they may lose a tooth or teeth” said Dr. Leda Mugayar of the University of Florida College of Dentistry. "One, you have deep cavities in a child’s mouth. Correcting the problem is more difficult because the pulp off the tooth is compromised and you are losing the vitality of the tooth.”

     Concerned by the growing number of children without access to dental care, in 2005 the Florida Academy of Pediatric Dentistry joined other medical groups in a lawsuit against the state. The suit, filed in Federal Court in Miami, sought to change the reimbursement rate to doctors, reforms doctors say would attract more dentists to the system. 

    The state has spent more than $5 million defending itself in the suit which currently sits before the court.    

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