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Accessing Dental Care for Persons with Disabilities
October 13, 2005

Individuals with disabilities often have a difficult time finding a dentist to provide care and one which accepts the low reimbursement rate of Medical Assistance which is the health care coverage for many. Often those with physical, mental, or intellectual disabilities require special care, including anesthesia, to receive dental services. Many direct service providers, especially those offering community living options, find themselves in the position of assisting the individual in obtaining dental care.

The issues relating to a lack of care and service options arise due to a variety of reasons including:

  • behavioral issues with individuals receiving services;
  • need for anesthesia to provide those services which also increases treatment time and legal liability;
  • low reimbursement rates and bureaucratic red tape from Medical Assistance;
  • dentists with minimal experience or medical school training regarding treating individuals with a range of disabilities;
  • high no-show rates among individuals; and
  • a shortage of dentists in some communities.

A lawsuit filed by Pennsylvania Protection and Advocacy and the Disability Law Project is being heard by the US District Court for Pennsylvania’s Middle District. The lawsuit demands improved access to medical and dental care for people with developmental disabilities. Similar suits have been filed in more than 20 states.

The state’s Department of Public Welfare indicated it will increase the fees on the Medical Assistance Dental Fee Schedule for dental anesthesia services and behavior management. Once approved the changes would be effective sometime in 2005.

The Pennsylvania Dental Association has members who participate in the Donated Dental Services program. Through this program adults and children who are medically compromised are referred to dentists who volunteer to provide free dental treatment. To be eligible for treatment individuals must be a senior citizen, or disabled or chronically ill, and have demonstrated a financial need (150% of poverty level) or have no dental insurance and require major dental treatment. The program has two coordinators; the Eastern Region Coordinator is Jennifer Gillette (717-238-8721) and the Western Region Coordinator is Valerie Stetz (412-243-4866).

Other resources for dental care:

1. The Pennsylvania Department of Health web site offering information on safety net clinics (non-profit, community sponsored dental clinics that offer services to individuals without access to dental care). Eligible individuals are either low-income or receive public insurance. Each program has its own limitations and availability of appointments. To identify a clinic by county access http://ecapps.health.state.pa.us/safetynet. Resources are also available at the Department of Public Welfare web site at www.dpw.state.pa.us/Family/003671559.htm.

2. Special Smiles, Ltd. is an outpatient dental facility specializing in the treatment of individuals with intellectual and physical disabilities. It is located at the Episcopal Hospital division of Temple University Health System. Persons must be at least 12 years old, in need of sedation for dental services and enrolled in one of the publicly funded medical plans (Access Plus, Americhoice, HealthPartners, or Keystone Mercy). For information contact the office at 215-707-1525 or access www.specialsmilesltd.com.

3. The University of Pittsburgh School of Dental Medicine’s Advanced Pediatric Dentistry Residency Program treats children from birth to age 18 and individuals who have special needs of any age. Special programs are offered in the treatment of persons with special needs, cleft lip/palate, craniofacial anomalies, and those who require sedation or general anesthesia. For information contact the program at 412-648-8618 or access www.dental.pitt.edu.

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