Emily Tuschen, executive director of Promise Community Health Center, and Amy McAlpine, chief operating officer, said they have been battling a shortage of dental providers for the past three years.
REGIONAL—Public health departments in northwest Iowa are trying to recover from a kick in the teeth, namely the dental care shortage that seemingly has no end in sight.
Public health providers in O’Brien County, Sioux County and elsewhere say they are being pushed to exhaustion trying to combat an ongoing shortage of dental providers who serve Medicaid patients. As a result, Medicaid patients are left with untreated cavities, missing or broken teeth, sores, and more.
“The I-Smile program is definitely a problem. Looking at these children’s teeth, they are very bad. Like between 10 and 20 cavities, and they’re 4 years old,” Korrie Ewoldt, O’Brien County Public Health Nurse Administrator, told the O’Brien County Board of Supervisors in October. “It’s a huge problem, but as far as the program goes, I don’t think they’re getting paid enough.”
I-Smile is a statewide program funded by the Iowa Department of Public Health. With slogans like “Healthy teeth enable learning,” northwest Iowa’s I-Smile@School program aims to provide dental exams and apply fluoride to children at WIC clinics, centers Head Start, preschools and daycares. and in schools.
But as Medicaid families increasingly rely on I-Smile for their children’s dental needs, a looming shortage and burnout threatens communities’ on-the-ground public health providers.
Serving Clay, Cherokee, Dickinson, Emmet, Lyon, O’Brien, Osceola, Palo Alto, Plymouth and Sioux counties as part of Collaborative Service Region 1, I-Smile is familiar to Northwest Iowans and can even be more familiar to them than to local dentists.
There is not a single general dentist currently seeing new child patients under Medicaid coverage in the 10-county region. This means that children covered by Medicaid in one of these 10 counties who need treatment for cavities, tooth decay or surgery must either pay out of pocket to see a local dentist or travel to the nearest dentist that accepts Medicaid.
“Currently, in our CSA 1 region, we do not have any general dentists in any of our counties who are accepting new Medicaid children. There is a community health center in Sioux Center, but they do not have a dentist at this time. Their two dentists quit last summer, which helped cover a lot of our kids, but we don’t have that anymore,” said Dawn Ericson, I-Smile coordinator for northwest counties. ‘Iowa. “We have the Dental Siouxland Community Health Center in Sioux City, they are accepting new children, but they are scheduled for three, four, sometimes six months. The United Community Health Center is in Storm Lake, they are not accepting new people at this time, or new children at all.
“So some of our kids travel all the way to Fort Dodge, a two-hour drive in our northern counties, to try to find a dentist. There’s a community health center there, but they’re pretty full outside as well.
Ericson has worked with I-Smile since its inception 18 years ago. She said a lot has changed since then.
“It’s just been a struggle. Five years ago, when I was in this program, other areas of the state were saying they were having trouble finding dentists,” Ericson said. “I never thought this would hit northwest Iowa, but it has now.”
The most recently released I-Smile Needs Assessment, using 2021 figures, recorded that 60% of children covered by Medicaid and living in O’Brien County could not access a dentist for an appointment. YOU. In Osceola County, 64 percent of children were unable to get an appointment. In Dickinson County, 71 percent of children were covered by Medicaid.
“And those numbers are higher today than they were then,” Ericson said.
Korrie Ewoldt, O’Brien County Public Health Nurse Administrator, fought for another sitting nurse at an October Board of Supervisors meeting, but was denied a motion.
Promise Community Health Center, a federally qualified health center located in Sioux Center, is the only health center qualified for enhanced Medicaid reimbursement between Sioux City and Storm Lake. As an FQHC, Promise Community Health Center is paid more by the government than private dentists to serve Medicaid patients.
Any dentist who is not part of an FQHC is reimbursed only 34.3 percent for Medicaid children’s dental services and 32.7 percent for Medicaid adult dental services, according to the latest data from the ‘American Dental Association Health Policy Institute dating back to 2022. Iowa has the 13th. Lowest reimbursement rate in the country for private dentists for adult services.
Last year, with two full-time dentists, Promise Community Health Center served 3,000 patients for dental services under Medicaid. Both dentists resigned over the summer for personal reasons, according to Promise CEO Emily Tuschen.
She said Promise has struggled with shortages of dentists and hygienists for the past three years. After the previous dentists left, Promise began working with a locum tenens recruitment agency for the second time in Promise’s history. Although Promise has hired two temporary dentists to cover services through July, they will not be working at the same time. With only one temporary dentist working at a time, and only until July, Tuschen said Promise’s search for a full-time dentist is ongoing, but it also continues to hit dead ends.
“Before even having access to a candidate, the recruiting agency will filter those who would be interested in those coming to northwest Iowa,” Tuschen said. “That filters out 98 percent of dentists. Rural health is difficult.
“They’re looking for mountains, not winters — those are specific things I heard from the recruiter regarding specific candidates,” she said.
Tuschen said Promise, ideally, would have two to three full-time dentists on staff and continue to grow from there.
Because Dordt University in Sioux Center and Northwestern College in Orange City offer no dental or hygienist programs, new recruiting efforts are made even more difficult.
Without the staff to provide early preventative treatment, Tuschen said Promise was forced to take care of its teeth when it was already too late.
“It looks like a storm,” Tuschen said. “We can’t provide preventative care, even though that’s what we want to do, so we see people for intensive care visits only or when they have tooth decay or whatever, so we treat that, but we still don’t clean it up because it’s very difficult to recruit a hygienist. It’s like a vicious circle.
Reflecting on Ewoldt’s fight to provide dental care in schools, Amy McAlpine, Promise’s chief operating officer, says Ewoldt is not alone.
“This is not just a problem in O’Brien County. We would definitely say the whole corner of the state. And what lets us know is that people are driving,” McAlpine said. “Like last year when we were fully open, a good number of patients were coming from Sioux County, but a large, large, large majority would drive an hour to two hours to Promise to get services. And the reason is they say, and this is the reality, that they can’t go anywhere else to get Medicaid services.
Two solutions are required:
First, Tuschen said, being able to recruit dentists and recent graduates to northwest Iowa.
Second, Ericson said, the government has provided additional funding for public health services like I-Smile.
Because both seem intangible right now, low-income Iowans are left with six-month waiting lists and long drives to the dental provider who will take them.
“As an organization, we are ready and willing to respond in our own clinic, expanding outside the walls of that clinic in another city if there were dental needs there that we could meet, rent a space, buy space,” Tuschen said. . “But we have to have a dentist to be able to do that.”
