Dental care isn’t accessible in much of southeast Ohio
Dental care isn’t accessible in much of southeast Ohio. Medicaid cuts could make matters worse.
By: Amanda Pirani
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REEDSVILLE, Ohio (WOUB/Report for America) — Hygienist Amy Satterfield tries to make dental care appointments a positive experience for her patients. During an afternoon cleaning, she promises the elementary student in her chair rewards for bravery.
“You are a trooper … I have some chapstick I’ll give to you when we’re finished,” she said.
In a space that once held classrooms, Satterfield spends each week treating local students and community members. She works at Hopewell Eastern Clinic in Reedsville, which opened in 2021 as a school-based health center.
Before then, she said families didn’t have many options for local dental care.
“None of this was started early enough for their parents. This is a huge opportunity to offer this in school systems,” she said.
That’s because the southeast region of Ohio is a federally designated dental health professional shortage area, meaning there aren’t enough dentists for the people living there. Satterfield is the only hygienist at the Eastern clinic, where she returned to work part-time after retiring.
That shortage means many families have to look far away from their home for dental care. A lack of providers who accept Medicaid can make the search even more difficult. Now, federal cuts to Medicaid passed in July as part of the One Big Beautiful Bill Act have advocates concerned that those access problems will only get worse.
Southeast Ohio doesn’t have enough dentists
Eastern Clinic is one of a handful in the area providing school-based services, which bring dental care to a place where children and families are already going. That gets around key barriers for families in rural areas like a lack of transportation, or taking time off work.
It’s also what the state refers to as a safety net dental clinic, because it provides treatments regardless of someone’s ability to pay. For someone on Medicaid, a safety net clinic is often the only provider in the area that accepts their insurance.
But six counties in southeast Ohio don’t have a safety net clinic. And even for those on private insurance, the options aren’t much better. Eight counties in Appalachian Ohio have less than 10 dentists to serve the population.
Amber Johnson, who manages the Eastern clinic, said staffing dentists has been a challenge for many of the sites she works with.
“We have a dental clinic in Racine that we do not have a full-time dentist for at this point in time,” she said. “We just recently were able to fill a dentist position in Gallipolis, at our clinic there.”
The region is not only short of dentist offices, but also hygienists like Satterfield and other staff that keep a practice running.
Susan Lawson, who directs oral health services for federally qualified health centers (FQHCs) in Ohio, said that lack of staff limits often leads dentists to take on additional work, limiting how many patients they have the time to see in a day.
“I have a lot of dentists doing cleanings, which doesn’t help because they’re not working at their highest practice,” she said. “It just kind of snowballs.”
One of those snowball effects is the long waitlists patients face for care.
Local career development can help
Lawson said it can be hard to incentivize oral healthcare workers to come to the region. Their potential income is often lower, and there can be more challenges, like finding people to staff a practice.
Instead, efforts to invest in local workers look more promising. Lawson said a statewide initiative helping staff at FQHCs become dental assistants has helped some centers increase their capacity.
The state also provides loan repayments for dentists who work in a designated shortage area treating low-income patients, to help incentivize working in areas like southeast Ohio.
Right now, there aren’t any schools of dentistry in the region. But a growing program at Hocking College has helped add to the area’s dental hygienist workforce.
While training at the school’s dental hygiene clinic in Perry County, students also provide reduced-cost care under the supervision of faculty.
Misti Malfe oversees the program, which will graduate 19 students this December. She said many of her students will already have jobs before they graduate, because of the demand she sees from local practices.
“Many of the students who go through my program are from this area … and they want to stay in this area,” she said. “So I think having the program alone has helped to fill some of that void where there’s not enough hygienists.”
Malfe said Hocking College hopes to expand the program to the school’s main campus in Nelsonville in the coming years, which would double its class enrollment capacity to 40.
Oral health care is still viewed as second to medical
Bailey Barrera has coordinated the Hocking College Dental Hygiene Clinic since it opened in 2019. She said her staff spend a lot of time explaining the importance of oral health care, which is often seen as less important than medical care.
“A lot of the times we like to educate people on … if you’re not taking care of your mouth, you’re not going to be healthy,” she said. “Because that bacteria travels to the rest of your body.”
Hopewell dentist Darcy Cook said insurance plans are part of the problem, because they often don’t give dental care equal weight.
“When you look at your benefits, you say, ‘Well, I’ve got all these medical benefits, but there’s no dental benefits to go along with it, that must not be as important,’” she said.
Many of the patients Barrera sees at the Hocking College clinic are those who weren’t able to get treatments covered at a private practice.
“They refer Medicaid patients to us when they can’t afford to pay for non-surgical periodontal therapy because it can cost upwards of $2,000,” she said. “Medicaid is not going to pay for that. So they send them to us and they get it essentially for free.”
Without a clinic, those on Medicaid or without dental insurance aren’t left with many options. Cook said most private practices can only afford to treat a limited number of low-income patients because of low Medicaid reimbursement rates.
Some clinics, like Hopewell’s community health centers, receive federal funding for their care because they serve low-income populations. Even with that funding, Cook said serving patients who are covered by Medicaid can be challenging.
“The reimbursement that we’re getting now, a lot of times, isn’t even enough to cover our costs,” Cook said. “So it’s almost forcing us to overload our schedules to kind of account for that.”
Medicaid cuts threaten efforts to increase access
A disproportionate number of patients in Appalachian Ohio rely on Medicaid for their dental care compared to rates statewide. Advocates worry that coverage could be threatened by millions of dollars in federal Medicaid cuts signed into law in July.
Oral Health Ohio Executive Director Marla Morse said the state legislature has been supportive of the dental benefit in the past. In 2024, the state raised the dental reimbursement rate, with the goal of improving access to dental care.
But Morse worries what might happen if the state budget is squeezed by the federal cuts.
“The thing that we are really concerned about is that we could be taking away optional services to save money, and … adult dental is an optional service,” she said.
Historically, states tend to cut or reduce funds for optional Medicaid benefits like dental care when finances are limited.
New eligibility requirements could also lead to coverage losses at the individual level. Morse said both of these scenarios would worsen the region’s access problem and lead to untreated care.
When dental issues aren’t treated, Cook said more extreme measures like a root canal or tooth removal become necessary.
“You might need an antibiotic, or you might end up losing the tooth,” Cook said. “Whereas before, we could have avoided that by just doing a very simple filling, if we would have been seeing them on a regular basis.”
Some of those untreated cases also wind up in emergency rooms, which is typically the most costly option for care.
From 2016-19 Ohio saw an estimated $738 million in oral healthcare related emergency room visits, according to the Ohio Department of Health. Most of those visits were for conditions that could have been treated by a dentist office.
“When people lose their coverage … they’re going to go to these federally qualified health centers, which already have waiting lists, and then they’re also going to end up going to an emergency room for a toothache, which is not the best place,” Morse said.
Amanda Pirani is WOUB’s Report for America Journalist covering Economic Livelyhood. For more information about Report for America, you can click here.
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