Dr. Marty Gamble treats about 2,000 local children on Medicaid, give or take a few hundred. But after next week, he won’t accept CoventryCares, which will leave about three-quarters of them without a dentist.
As it is, hardly any dentists in Christian County treat adults on Medicaid. And only one besides Gamble treats children.
“It’s definitely a crisis,” Gamble said.
Gamble said CoventryCares reimburses him at roughly half his ordinary fees. Because he does not specialize in children’s dentistry, he will be subject to an upcoming 10-percent cut in the reimbursement rate. He and Mark Pyle, director of the Christian County Health Department, petitioned the company and the state government to cancel the cut.
“That’s my overhead plus some,” Gamble said. “I’m not going to go into the hole because you all want to make a profit.”
Medicaid is the federal-state health insurance plan for the poor and disabled. As of December, more than 6,500 Christian County children were enrolled, and there were more than 2,500 in Trigg and Todd combined.
Since late 2011, Kentucky has contracted with Coventry and two other private companies to manage its Medicaid system. A multitude of problems has ensued, including long delays in reimbursements to doctors and hospitals.
This year’s County Health Rankings survey reported that Christian County has state’s highest ratio of dentists to patients. But this calculation came from faulty data.
Using a database of the U.S. Health Resources and Services Administration, the survey reports that Christian County has 92 dentists. However, according to records from the Kentucky Board of Dentistry, this county only has 22 dentists with active licenses, and eight of those practice at Fort Campbell.
The New Era talked with representatives from the Health Resources and Services Administration and the County Health Rankings survey. It remains unclear where the error arose.
Among the 14 local dentists serving the public, only four treat any Medicaid patients, and some at least doesn’t accept new patients.
Gamble said Medicaid patients from Princeton, Hopkins, Trigg and Todd counties drive to his office. Besides Dr. William Nunn, who treats Medicaid patients in Hopkinsville, Gamble believes the other closest options are in Hopkins and Warren counties.
Nunn said two-thirds to three-quarters of his patients are on Medicaid. Coventry will not cut his reimbursement rate because he specializes in treating children.
Sometimes children on Medicaid come to Gamble’s office after going years without seeing a dentist. He has filled 15 or 20 cavities in some children’s mouths. At least once, he had to remove all of a high school student’s front teeth.
In a letter to the Kentucky Cabinet for Health and Family Services, which he shared with the New Era, Pyle argued that cutting the reimbursement rate would hurt the public.
“This is a detriment to the access of primary oral health care in Christian County due to the shortage of dentists who accept Medicaid patients,” he wrote.
In her response, Audrey Tayse Haynes, the cabinet’s secretary, said dentists would need to negotiate the matter directly with Coventry.
“Although decrease in fees are not easy for anyone (sic), they are sometimes necessary to ensure that our current system of healthcare is sustainable and will continue to meet the daily needs of our citizens,” she wrote.
Gamble said he submitted a phone complaint to Coventry but received no response.