An estimated 120,000 new adults are projected to be eligible for dental care through the Iowa Health and Wellness Plan, Iowa’s version of the Medicaid expansion, under the Affordable Care Act.

That means the dental system will need to adapt. As a first step toward determining how it will need to do that, the University of Iowa’s Public Policy Center and College of Dentistry conducted a survey late last year to investigate the current state of access to dental care in Iowa, assess capacity of the current dental safety net, and identify current gaps in the system.

Published in December, the survey was conducted of all private dentists in Iowa to determine their level of participation in Medicaid and their attitudes toward the program and treating underserved populations. Read the full report here.

“Overall, dentists have highly altruistic attitudes,” says Susan McKernan, visiting assistant professor at the Public Policy Center and the study's primary investigator. “Almost all of the dentists that we surveyed agreed that dental care should be available for needy patients and a majority recognized that the Medicaid program is essential to providing low-income patients with necessary dental care.”

The survey found 16 percent of Iowa dentists were willing to accept all new Medicaid patients without conditions, down from 42 percent in 1995 and 62 percent in 1992. Another 42 percent of dentists would accept some new Medicaid patients into their practice.

Additionally, 85 percent of Iowa dentists who do not accept new Medicaid patients also reported that they had not seriously considered changing their position. Moreover, more than half of those who accept at least some new patients indicated that they had considered stopping their participation.

The survey also found that 58 percent of dentists in Iowa report accepting either all or some new Medicaid patients, though this is down from 64 percent in 1995, the last time the Public Policy Center and College of Dentistry conducted a survey of Iowa dentists.

While all dentists agree that Medicaid patients have more oral health needs, they cited complicated paperwork, low reimbursement rates, denial of payment, and canceled appointments among the reasons for turning down new Medicaid patients.

A planned follow-up study will provide additional perspectives on the factors that dentists believe are most important when considering whether to participate in Medicaid, and examine the capacity within the dental clinics at Community Health Centers in Iowa to provide dental care to vulnerable populations.

“Understanding the perceived barriers to participation in Medicaid can help design new programs or improve the existing program in ways that can encourage participation,” the study says.

Primary investigators on the study were McKernan, Julie Reynolds, Raymond Kuthy, Elham Kateeb, Nancy Adrianse, and Peter Damiano.

The DentaQuest Foundation, a Boston-based organization that advocates for improved oral health, funded the study.