By Nicoleta Serban, PhD, contributing writer

July 13, 2016 -- More than 58% of Georgia's children -- about 1.5 million youngsters -- qualify for public dental benefits through the state's Medicaid and PeachCare for Kids programs, according to a new study by the Georgia Institute of Technology (Georgia Tech). Unfortunately, of the 3,872 licensed dentists providing provide preventive services in Georgia, just 337 -- 8.7% -- accept public insurance for children, according to

Nicoleta Serban, PhD
Nicoleta Serban, PhD.

Research conducted by scientists in the Health Analytics Group at Georgia Tech details the extreme oral healthcare disparities between children eligible for public insurance and those whose families can afford care through other financial means.

Considering common access barriers, roughly 865,000 Medicaid- or PeachCare-eligible children in Georgia need to travel more than the state standards to reach a dental provider for preventive care services. The standards are driving distances to a provider of 30 minutes or 30 miles for urban areas and 45 minutes or 45 miles for rural areas.

They also must travel, on average, 10 or more miles farther than children with private insurance or ability to afford of out-of-pocket care expenses to reach a dental provider.

The study also found that the parents of more than 500,000 children in Georgia will probably forgo preventive dental care for their children because of the lack of financial means to pay for out-of-pocket care or lack of public or private insurance.

To address the problem, the study found that 30% of Georgia dentists (a total of 1,160) would have to accept public insurance to achieve state standards for access to care for almost 100% of Medicaid-eligible children in large cities and approximately 85% in smaller urban and rural areas.

To provide dental care for these children at "equitable levels" with those whose parents can afford the care would require that 50% of Georgia dentists accept public insurance reimbursement.

Tooth decay is the No. 1 childhood chronic disease, according to the U.S. Centers for Disease Control and Prevention. It not only results in pain and lack of concentration, but also can result in facial disfiguration from swelling, nutritional deficiencies from inability to chew, and potentially deadly infection. Lack of access to dental care also leads to missed school days for children and missed work days for their parents.

“An urgent plan of action is needed to ensure lower-income Georgia children receive the oral healthcare they so desperately need.”

The Georgia Tech research shows that an urgent plan of action is needed to ensure lower-income Georgia children receive the oral healthcare they so desperately need.

Among the strategies to reduce oral health disparities among lower-income children, the researchers propose providing grants to health centers that provide dental services, increasing Medicaid acceptance rates among dentists, and offering dentists federal assistance for dental school loans if they agree to relocate to dental shortage areas.

One strategy highlighted by the researchers was the focus of legislation proposed during the 2016 Georgia General Assembly session. The legislation would have enabled licensed dental hygienists to provide essential preventive dental care, such as fluoride treatment and applying sealants, without direct supervision of dentists, which is defined as requiring a dentist to be present onsite for the procedures.

The legislation would have expanded that policy, which applies now to prisoners and those seen at public health dental sites, to include state-insured children and underserved people in nursing homes, federally qualified health centers, and nonprofit healthcare facilities. Unfortunately, the measure met opposition from dentists and died in the House Rules Committee.

Nicoleta Serban, PhD, is a Coca-Cola Associate Professor at the Georgia Institute of Technology School of Industrial and Systems Engineering and the author of the study mentioned in this Second Opinion.

This commentary first appeared on the website of the Georgia Public Policy Foundation. is grateful for the opportunity to reprint this essay.

The Georgia Public Policy Foundation is an independent think tank that proposes market-oriented approaches to public policy to improve the lives of Georgians. Nothing written here is to be construed as necessarily reflecting the view of the Georgia Public Policy Foundation or as an attempt to aid or hinder the passage of any bill before the U.S. Congress or the Georgia Legislature.

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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Copyright © 2016

Last Updated hh 7/12/2016 2:51:23 PM

4 comments so far ...
7/14/2016 2:18:47 PM
In my opinion the primary reason why only 8.7% -- accept public insurance for children most likely is the fees are 50-65 % of the average fees. Most dental offices operate on a 50% overhead that means that the dentist is doing procedures at a 0-15% loss. If a small group of the dentists were to accept public insurance for children their practice may become 90-100% public insurance. The dentist would be operating at a loss, have no money to pay staff and other practice costs  and bankrupt. What would work is a requirement that all GA dentists accept public insurance for children. That would spread the loss over all GA dentist's and that loss could be absorbed with out much hardship.

7/15/2016 5:38:28 AM
 I understand why some would think that that only 8.7% of dentists in Georgia accept public insurance.  However, data shows that 50% of dentist in Alabama, 50+% in Mississippi, 28% in North Carolina and 35% in South Carolina accept state insurance.  These are Georgia’s neighboring states in the south.

Dr. Serban’s article clearly states that it would take 30% of dentists in Georgia to accept Medicaid/CHIP insurance for low income children to have access to preventive dental services at the state level standards
But it would take 50% of dentists in Georgia to accept Medicaid/CHIP insurance to close the disparity gap between public insurance and those with other financial access.

Am I the only one that finds it extremely odd that the Georgia Dental Association continues to purport a myth that "access" is not an issue in the state, when research conducted by unbiased scientists in the Health Analytics Group at Georgia Tech details the extreme oral healthcare disparities between children eligible for public insurance and those whose families can afford care through other financial means?

7/15/2016 8:48:23 AM
You missed the business aspects of my comments! I tried to give you a solution a state law the requires all dentist to treat at least 5% but no more than 8% medicaid. That would spread the losses to all dentists just not a few which in turn may cause the few to loose so much money that they would go bankrupt due to the low medicaid fees. 

4/25/2017 4:59:46 PM
dkmacleod, You proposed a "state law that requires all dentist to treat at least 5% but no more than 8% medicaid. That would spread the losses to all dentists". I see a LOT wrong with your proposal.
1- I think it would be impossible for you or anyone to explain why the cost burden of treatment should be borne by the state's dentists. (Would you propose that the state's hotels and motels should be in a program to provide 5-8% of their rooms to the homeless? Food vendors, restaurants, groceries, etc should be in a program that gives 5-8% to the hungry? While we're at it, the banks should...ok, I'll stop there, but you get the drift.)
2- Like all other programs and insurance PPOs, if the program stinks, very few providers are willing to sign on.  That Georgia's medicaid has so few providers signing on shows that the program falls short of most dentists' sense of reasonableness. The chances are that other states have higher participation because their Medicaid program doesn't stink as bad as Georgia's. 
3- Unlike your proposal, fixing the Medicaid program shares the burden with all the taxpayers...a much larger base and the correct one for the notion that those in need should be helped. It is a public sector issue...and it is inappropriate to legislate that a select group of private citizens be forced to deal with a public problem.
4- Suppose your proposal is taken seriously... and after a year it is determined that the minimum be raised to a minimum of 10% to meet the needs in a more timely manner. And then in another year, perhaps it is suggested that the minimum be raised to 13.5%. While it never should have started in the first place IMHO, it also would seem like it would never end. How could the proposed minimum keep rising? When statistics talk about how many people say they need care but don't go because they can't afford it, the numbers aren't tellling the whole story. Many, many adults don't go until they're in pain. Many, many parents don't take their kids until the kid is suffering.  In both cases, the ER is more convenient than going to the dental office they've been avoiding for a loooong time. A large part of the problem is behavioral and not one for which the privately owned dental offices of Georgia should be charged with fixing.
   Separately, consider the geographic problem where there are no dentists nearby. Mandating that dentists treat people on Medicaid will not be a fix for any of the people in need in those areas.
   In other words, the problem is not fixed by a mandate for more providers, but to fix the system that provides care to those that cannot pay for it AND put providers in areas of need.