Percentage of children on Medicaid age 1-18 receiving dental services2000 - 2005 - 2009United States 29.8 - 36.1 - 43.8Alabama 23.9 - 41.2 - 49.9Georgia 24.5 - 41.3 - 42.5Tennessee 29.5 - 41.7 - 46.4Source: The Pew Center on the States
In the last 10 years, Tennessee, Georgia and Alabama have made huge strides in how many low-income children receive dental services
And while the states now exceed the national average, advocates say they still have room for improvement in providing preventive services and access to dental care, noting that only about half of all low-income children receive the services.
In a Pew Center study released last year, Georgia received a B, while Alabama and Tennessee each received a C for children's dental health within certain benchmarks.
"Other states have called us to see how our program works," said Dr. Jim Gillcrist, TennCare Dental director.
The Pew study evaluated states on eight policy indicators, including how many children on Medicaid received dental services and whether schools with low-income students have programs to apply clear plastic coatings that help prevent cavities.
"Basically, it's simple -- children with poor dental health are likely to grow up with adults with poor dental health," said Shelly Gehshan, director of the Pew Children's Dental Campaign. "But you have to remember that we set the benchmarks really low. If we had set them where we wanted, every state would have gotten an F."
Tennessee's Program
In Tennessee, the low-income dental program for kids once was part of TennCare, a program Gillcrist said had low utilization numbers for the kids it was supposed to serve and low numbers of dentists who wanted to jump through the hoops to use it.
In 2003, the state overhauled the program and contracted with a dental benefit manager to oversee the program, which is still under TennCare but has its own advisory board.
"Things began improving; a lot of red tape was cut," said Gillcrist.
Now the program has close to 1,000 dentists approved to provide care, nearly one-quarter of the state's total.
The program has received high marks from both dentists and clients, Gillcrist said. About 94 percent of enrollees said they were very or somewhat happy with their dental plan, while 95 percent of dentists gave it high marks.
But Michele Johnson, with the nonprofit law and advocacy group Tennessee Justice Center, cautioned that the picture might not be quite as rosy.
"It's improved but it's still not completely fixed," she said.
The Justice Center is especially concerned that special-needs kids are not adequately covered to get the treatment they need at dental surgery centers, she said.
In addition, Gehshan said having one-quarter of the state's dentists providing care through the program might be an improvement, but it's still a low number considering how many kids are enrolled in the program. About 41 percent of Tennessee's children -- more than 729,000 -- use the TennCare dental program.
"Medicaid kids are higher risk and more medically needy," Gehshan said. "Less than 25 percent does not sound like a bargain to me, especially since most dentists are clustered in cities and not where these patients are."
Alabama's nonprofit model
The Pew study found that the United States has a shortage of more than 6,000 dentists. In Alabama, about 25 percent of the population is unserved, with only four other states having a higher percentage of people who do not have access to a dentist. In Tennessee, the number is 21 percent, while Georgia's numbers are much lower at nearly 11 percent.
Most states have laws to govern who can open a dental practice and, in general, only a licensed dentist can own a practice or employ another dentist.
"They are often very tightly constructed to eliminate or prevent clinics or non-traditional providers for operating in states; they are deliberately designed to keep out innovation," Gehshan said.
Jeffrey Parker, CEO of Sarrell Dental clinics, knows about the laws. Sarrell is a nonprofit that provides care to Medicaid kids in Alabama, taking only Medicaid fees with no government grants or private donations. It operates more like a hospital than a dental clinic, with a chief dental officer who oversees and peer-reviews all dentists on staff, Parker said.
There are now 14 Sarrell clinics spread across the state, providing care to more than 105,000 kids last year.
Parker, a retired businessman, took over the non-profit Sarrell clinics in 2005 and waged a battle with the Alabama Dental Association and the Alabama Board of Dental Examiners for several years. Before the governor signed a law in 2011 that gave Sarrell the right to continue operating in the state, the dental groups opposed the clinics, calling them "illegal."
In a tour of its offices in Anniston, Ala., Parker doesn't talk much about the hard-won fight. Instead, he focuses on the success of the model -- the clinics' call center, the area where all kids have their blood pressure taken and the electronic records system.
"The people who work here know you treat every child who walks through the door as your son or daughter, or you don't work here," he said.
Under Parker's leadership, the nonprofit has managed to drive down its operating costs per patient from $328 in 2005 to less than $129 in 2010. It pours all its money back into opening more clinics, Parker said.
"Medicaid pays enough money," Parker said, talking about how his business model works.
With his fight with the Alabama Dental Association behind him, Parker said he is looking to expand his idea. Tennessee -- which pays 11 percent more in Medicaid fees for dental work -- and Georgia are both in his sights.
"If the people of Tennessee want us to help the children of their state that have no access to dental care, we're willing to come immediately," Parker said. "We'll be there in 2012."
David Horvat, executive director of the Tennessee Dental Association, said he doesn't know that much about Sarrell. But he said nonprofits and faith-based clinics have long operated dental centers in the state.
"We absolutely have nonprofits operating in the state now," Horvat said.