Medicaid Rules Said to Worsen Black Men's Dental Problems

Photo Credit: Don Baker Dr. Gail C. Christopher, director of the Joint Center for Political and Economic Studies' Health Policy Institute, responds to questions at briefing on oral health, with U.S. Surgeon General Richard H. Carmon, center, and Dr. Caswell Evans, director of the National Oral Health Initiative.

Medicaid participation requirements are excluding too many African American men, a new study says, contributing to statistics that show that more than 50 percent of African American men have untreated dental decay, compared to 28 percent of white men.

The dental decay figures come from the federal government’s Third National Health and Nutrition Examination Survey.

Low-income men who are young or middle-aged usually find that they are not eligible for Medicaid, a program in which federal and state governments provide financial assistance to people with low income and resources. Medicaid is granted only to the elderly, blind or disabled, and to pregnant women and children.

The recommendation on Medicaid is included in a new report, “Visible Difference: Improving the Oral Health of African-American Males,” which was presented by the Health Policy Institute of the Joint Center for Political and Economic Studies on June 10.

The Joint Center informs major public policy debates through research to improve the socioeconomic status of black Americans.

“This is a groundbreaking document,” said Shelly Gehashan, the program director for the National Conference of State Legislatures. “I hope it receives a lot of attention. I hope people read it carefully.”

Research by the U.S. Department of Health and Human Services indicates that only 16 percent of dentists participate in Medicaid.

Moreover, rising costs have caused many employers to drop dental benefits completely. Only 60 percent of full-time state and local government workers have dental coverage, according to a report by the Bureau of Labor Statistics.

In addition, African American men record the lowest oral cancer survival rate of any population group in the nation. African Americans survive oral cancer five years or more 34 percent of the time, while 55 percent of whites will live that long with the disease, said the National Institute of Dental and Craniofacial Research.

Dr. Ronald E. Inge, associate executive director of the division of dental practice at the American Dental Association, is responsible for developing strategies to increase access to care and prevent diseases.

"A large majority of African American males, because of their socioeconomic status, are forced to rely on government assistance for their oral health care," said Inge, who is African-American.

The report mentions that in the inner city, some African Americans receive a “lesser quality education” because of poor public school systems, which hinders their ability to acquire high paying jobs.

"We need to look into more scholarships and more educational opportunity in support of those who would seek professional careers," said Dr. Gail C. Christopher, director of the Health Policy Institute for the Joint Center.

A federally funded “oral health safety net” has made strides to improve the oral health of African Americans, according to the authors of the report. The safety net includes hospitals, community health clinics, public school and dental schools.

A National Health Survey by Columbia University conducted in 2000 found that one in five African Americans uses these facilities as a main source of dental care.

While these providers can have only a limited impact because those dentists work for relatively low wages, strengthening these facilities could help eliminate the health disparities.

The experts also urged more diversity in the dentistry field. "On a personal note, I had no mentors,” said Inge, who worked 15 years in private practice. “I was fortunate enough to discover dentistry through other means.”

Most African American dentists are educated at historically black colleges and universities. Howard University and Meharry University train the most.

Oral health is important because oral diseases affect the ability to eat and communicate. Tooth decay and gum degeneration can lead to diabetes and cardiovascular disease.

Geshashan, who is the author of the report “Access to Oral Health Care Services for Low-Income People,” said that oral health can affect many aspects of a person’s life.

"There is no more clear class marker in this world than poor teeth," said Gehashan. "We have to tackle that because it's a clear link to the ability to get jobs, the ability to do well in school, and the ability to thrive."

Gehashan has collaborated with states to help them adopt the State Children's Health Insurance Program, a federal partnership enacted in 1997 that provides health insurance coverage to children in families with incomes too high for traditional Medicaid, but who cannot afford private coverage. Gehashan said it was difficult to set up national oral health standards.

Gehashan said it was difficult to set up national oral health standards.

"There are some legislators that care about [oral health], and probably a lot of governors who care about it," Gehashan said. "It's not easy to work on an issue when there are so many other larger crises out there that they have to respond to."

Other strategies discussed in the report include setting national standards for the oral health of African American men, developing outreach strategies that specifically target African American men and expanding the data collection efforts by gender and race.

Dr. Amid Ismail, director of the Detroit Center for Research on Oral Health Disparities, said he was encouraged by the recommendations in the report.

"The focus of the new initiatives should empower African American males to take action to improve their oral health," he said.

Titus Ledbetter III is a student at Hampton University.

Posted June 24, 2004