The Gap

Medicaid's toothless protection for poor kids

Feb 13, 2002 at 4:00 am
As news tips go, this one sounded less than believable:

Did you know that the Children's Hospital dental clinic will see your kid for regular care, but only if you've got private health insurance? Did you ever figure that they won't take Medicaid or MC+ patients unless an extreme special need is involved?

Hold the phone.

St. Louis Children's Hospital is one of our great institutions, having saved thousands of kids' lives. It's a charity, one that would never discriminate against the poor.

Try the phone.

Make two calls to the dental clinic for a routine appointment -- one in which you pretend to be a dad whose family is covered by Medicaid and MC+ for Kids (part of the federal Children's Health Insurance Program for low-income families), the other in which you play a dad with private Delta Dental coverage.

First call:

My son's got a toothache, and I'd like to bring him in. Will MC+ cover it? A polite woman named Melody says she's sorry but that the clinic only sees Medicaid/MC+ patients if there is a special need, such as Down's syndrome. She suggests calling MC+ to find a dentist who accepts the plan.

Second call, hours later:

I'd like to bring my son in for a checkup and have his teeth cleaned. Do you take Delta Dental? Melody again, still polite but with a different message: We'd be happy to see him, but we're not taking appointments until June. Can I set you up for then?

Holy tooth decay, Batman, they do discriminate against poor kids at Children's Hospital. What's with that?

It turns out there are two explanations, one a sign of the times from the world of charity, the other a sign that the Apocalypse is upon us in Missouri. Both are bad signs.

The charity point is simple: When it comes to dental care -- and only dental care -- Children's Hospital is not a charity. It's a landlord.

The dentistry program at St. Louis Children's Hospital is run by the Premier Dental group, which is a private practice, says Jim Williams, media-relations coordinator for the hospital. Its two dentists, working part-time, pay rent to the hospital. They're just like any other private practice in Missouri.

In fact, Williams says, they're already going above and beyond the call of duty.

They do accept Medicaid through Care Partners (the insurance arm of BJC HealthCare), and they see medically compromised patients as a courtesy to Children's because it's part of the hospital's mission, Williams says. That's regardless of insurance status.

But Children's has hardly gone above and beyond the call in publicizing the contract arrangement for dental services, the only one of its kind in the hospital. No sign exists at the dental clinic advising that it is not officially part of the hospital. Nor is the private status indicated on the hospital's Web site, although a surf stop there reveals that of 75 services listed, dentistry is the only one not linked to another page. What that means, they really weren't able to say.

The dental clinic was clearly part of the Washington University School of Dental Medicine until 1991, when the school closed its doors. The private status of the dental clinic -- arranged in 1999 -- may not be a secret, but nowhere is it overtly publicized.

That fine distinction isn't fine with everyone.

Pediatric dentist Homer Sedighi, who worked at Children's for seven years and still uses its facilities for hospital dentistry, is highly critical of the contract and charges that this private clinic blurs its uncharitable status by using the hospital name in correspondence and other business. What's more, he produces a letter written to him July 17 about a scheduling issue in which Children's president Ted Frey discusses the hospital's agreement with Premier Dental:

"We have consistently viewed this as an administrative change and have continued to view the pediatric dentists contracted through Premier as SLCH-based dentists."

Is this a treasured charity or just a plain old dental practice? Or maybe a hybrid -- a charity that is relentlessly pursuing the old bottom line, no matter who gets hurt in this cost-cutting chase?

You make the call.

Sedighi's main criticism, however, is not with labeling; it's with policy.

"Since this is an organization supported by Children's Hospital, they should treat everybody the same regardless of their social background," Sedighi says. "They shouldn't discriminate against Medicaid and MC+ patients."

Sedighi says the dental clinic was operated at a loss of $6,000 to $10,000 per month when he was there in the 1990s and that the hospital could afford the deficits because it got block grants from the state to care for Medicaid patients. He opposes the arrangement to contract for outside dental services.

Children's Hospital should have a larger responsibility to provide dental care for underprivileged kids, Sedighi says. It's a not-for-profit institution and a large organization. If Children's can't provide this care, who can?

Apparently, just a handful of dentists in Missouri. This brings us to the larger issue, which is truly stunning: Barely 15 percent of the dentists in the state will see Medicaid/MC+ patients (of any age) because of problems -- both real and perceived -- with the program, says Jake Lippert, executive director of the Missouri Dental Association.

Lippert says that although Medicaid reimbursement has increased dramatically in recent years, it still covers barely half the fees customarily charged, so dentists actually lose money seeing poor patients. It's hard to blame private dentists -- at Children's or elsewhere -- for turning away Medicaid patients.

But that doesn't make it right. And when even a revered and powerful institution such as St. Louis Children's Hospital finds itself taking only privately insured patients (except in dire cases), it's pretty clear what poor kids are receiving in Missouri.

That would be a kick in the teeth.