This courtroom drama unfolds in federal court without much fanfare or publicity. The result of the decision effects people and dental offices throughout the commonwealth.
The defendants are Mitt Romney and members of his administration by name in their official capacity. The plaintiffs are hundreds of thousands of citizens including about a half million children enrolled in MassHealth.
The claim is that MassHealth does not provide federally mandated adequate dental care. The result is that since March 2002, MassHealth only covers most adults for emergency dental care and children who retain full dental coverage, are often unable to find dentists who will provide care.
Who are the plaintiffs? Recipients of MassHealth are people with disabilities, low-income families, pregnant women, and Social Security recipients. People who receive MassHealth cannot afford to pay for other health insurance or to pay out of pocket for dental treatment. MassHealth or Medicaid is an important part of America’s welfare safety net.
The problem is wide-ranging and serious. Dr. Rob Compton, chief dental officer of Delta Dental of Massachusetts, testified on Oct. 20, 2004, the third day of testimony. Compton quoted a 1999 special legislative commission report that found that only 33 percent of children covered by MassHealth received dental care.
A survey, performed by the Office of Oral Health of the Massachusetts Department of Public Health last year, in elementary schools around the commonwealth, including Malden, found that 41 percent of children with MassHealth coverage had untreated tooth decay. Untreated decay leads to the very high utilization of dental emergency services at ten times the rate of children covered by Delta Dental insurance.
Those numbers translate into a large number of children going to bed in pain every night. Those numbers represent parents who are unable to find someone to help their child. Those children are a large segment of the plaintiffs in this lawsuit.
Health Care for All v. Mitt Romney is an effort to expose the weaknesses in the MassHealth dental system. The primary problem is the small number of providers. On the sixth day of the trial, Dr. David Noel, chief dental consultant for California’s Medicaid program, Medi-Cal, pointed out that only about one-tenth of dentists who practice in Massachusetts participate in MassHealth.
Noel’s testimony illustrates one of the reasons that dentists are wary of participating in Medicaid; Noel mentioned that almost one third of California’s top Medicaid billing dental practices are under suspicion of fraudulent billing practices. This level of suspicion appears to be rife in the Medicaid program. Many dentists are unwilling to associate with any organization that exhibits such a high level of distrust of the profession.
The lawsuit brings all of the reasons for low dentist participation to the surface. The fees paid by Mass Health do not cover the costs associated with providing the level of care patients have come to expect from their dentists. Compton pointed out that even the new fees MassHealth bases their 2005 fees on old data. Therefore, the fees remain too low to attract an adequate number of volunteer providers.
Another problem is that dentists who accept MassHealth must accept every MassHealth client who calls for an appointment. Dentists who are the sole MassHealth provider in their area may find that MassHealth becomes a large portion of their practice. HCFA is pushing the state to change this regulation to allow dentists to limit their participation to a manageable number of Mass Health funded patients.
Many dentists who accept MassHealth do not like to advertise their participation. Dr. Robert Baskies is not one of them. Baskies has always accepted MassHealth. He runs a busy practice under his own name in his hometown, Chelsea. He is a dentist who manages his practice as both a business and a public service. As one of the top Medicaid billers in the state, his thoughts and feelings about the program run counter to the dental mainstream. The comparatively low fees and the non-standard billing system of MassHealth do not trouble Baskies.