In early December 2024, Dr. Michal Herman received a common type of email in her 25 years as a dentist. A teacher from a Newark school reached out about a 6-year-old student facing severe dental issues—his teeth were decaying, and he was homeless. When the child arrived at the KinderSmile Foundation in Essex County, Herman discovered that 16 out of his 22 teeth required extensive treatments such as fillings, extractions, or root canals.
“It’s not uncommon for us to see children in this condition,” said Herman, the chief operating officer at KinderSmile, which provides dental care to low-income children. “This happens frequently.”
A Deepening Crisis: Dental Care for Low-Income Children in New Jersey
New Jersey has one of the highest average household incomes in the nation, yet a staggering 36% of the state’s third graders suffer from untreated tooth decay—nearly double the national average of 20%. The problem is even more pronounced among Black and Hispanic children, as well as those from low-income neighborhoods.
The root cause of the widespread oral health crisis is the lack of accessible dental care for economically disadvantaged children. Advocates say that the primary barrier to care is insufficient access to Medicaid-accepting dental providers, particularly in a state where the vast majority of dental practices do not accept Medicaid.
The Struggles of Medicaid Patients
A recent survey conducted by the New Jersey Health Care Quality Institute highlighted the difficulties low-income families face when attempting to find dental care through Medicaid. The survey found that fewer than 50% of dental practices listed as accepting Medicaid actually honored the appointments. Many of those that were reachable confirmed they did not accept Medicaid after further inquiry, with less than 10% of the state’s 4,500 dentists willing to treat Medicaid patients.
Linda Schwimmer, CEO of the Health Care Quality Institute, pointed out that these findings underscore a major healthcare disparity in New Jersey. “Dental health is integral to overall well-being, affecting infection rates, nutrition, and a child’s ability to focus in school,” Schwimmer explained. “Yet, for too many children, getting access to a dentist is an overwhelming challenge.”
The Low Reimbursement Rates of Medicaid
The primary reason why many dentists reject Medicaid patients is the program’s low reimbursement rates. Medicaid pays far less for procedures like routine exams and tooth extractions—often covering only $25 for an exam and $75 for an extraction, compared to $90 and $190, respectively, for privately insured patients. Some of these Medicaid rates are so low that, as Dr. Herman aptly noted, “Some of the rates are less than a manicure.”
These low reimbursement rates, which haven’t been updated since 2007, are a significant deterrent for dental practices to accept Medicaid. With pediatric dental care accounting for $50 million of New Jersey’s $20 billion Medicaid budget, advocates are also concerned that further cuts to Medicaid funding could exacerbate the crisis.
The Impact on Children with Special Needs
For children like the 6-year-old patient at KinderSmile, the barriers to care are even more daunting. Not only does this child face a host of dental issues, but he also has developmental disabilities, a parent battling cancer, and is homeless. Dr. Herman anticipates the child will require multiple visits—likely four to five—due to the severity of the decay and his special needs. Each visit will address a quarter of his mouth at a time to minimize pain and promote healing.
However, the long-term outcome for this child remains uncertain. “We hope he can return regularly to prevent this from happening again,” said Herman, adding that consistent follow-up care is critical, but whether the child can continue treatment is not guaranteed given his circumstances.
A Broken System and the Need for Change
The struggle to access dental care is a glaring example of a larger problem: a broken system that neglects the oral health of vulnerable children. Without sufficient coverage and support for Medicaid providers, many children in New Jersey will continue to suffer from untreated dental issues that impact their overall health, education, and quality of life.
“We need to fix this system,” Schwimmer said, urging insurance companies and Medicaid administrators to update provider directories to ensure that patients can actually access care. Until changes are made, the cycle of neglect and untreated dental decay will persist, leaving many children like the 6-year-old at KinderSmile without the help they desperately need.
Looking Toward Solutions
The work of organizations like the KinderSmile Foundation remains crucial in offering care where traditional healthcare systems fail. However, without a systemic overhaul that addresses both accessibility and the underfunding of Medicaid, many children in New Jersey will continue to experience preventable dental problems that affect their health and futures.
This troubling reality highlights the need for more investment in the state’s dental care infrastructure, particularly for low-income families and children with special needs. Until that happens, the disparities in access to oral health services will remain a pervasive challenge in New Jersey.
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