Trying to find a doctor or a dentist in Erie County who accepts Medicaid is "a pain," Sandusky mother Jaimen Gentry says.
Gentry, 28, held one of her three children in her lap as she sat last week in the mobile dental clinic that comes two or three times a month to the Erie County Health Department's parking lot. The mobile clinic accepts payments from Medicaid families such as Gentry's.
"Before we knew about them, the only dentist who took Medicaid was way out on Bogart Road. We couldn't get there," she said. "I like this dentist, but everywhere else it's a pain in the butt."
Getting a doctor also can be difficult, Gentry said.
She said she takes her family to the Family Practice Clinic at Firelands Regional Medical Center. Young doctors in the hospital's residency program provide medical care at the clinic, which accepts Medicaid.
"It takes forever to get an appointment," she said. "When we still had Providence Hospital, I didn't have as much problem with them."
Officials at the Ohio Department of Job and Family Services say they are aware of the problem, although statistics suggest the situation in Erie County is getting better. It's generally harder to find a dentist who will take Medicaid than to find a doctor, several health officials told the Register.
Health care providers say what the government is willing to pay falls far short of the actual cost.
In 2006, government payments to Firelands Regional Medical Center for Medicare and Medicaid patients fell $15.5 million short of actual costs, according to a hospital brochure.
State officials have tried to improve the situation.
The new two-year state budget, which took effect July 1, hikes Medicaid payments to physicians by 3 percent each year.
Starting Jan. 1, Medicaid in Ohio will cover children in families that make up to 300 percent of the federal poverty level. The current limit is 200 percent. Gov. Ted Strickland has made expanding health care to Ohio families one of his top priorities.
As more families are added to Medicaid, the pressure to find doctors and dentists willing to treat them will increase.
The situation became more complicated about a year ago, when the state began pushing Medicaid recipients to enroll in managed care plans. Families in Erie County's Medicaid program for families and children can choose among three HMOs: Anthem, CareSource and WellCare of Ohio.
It's important for Medicaid recipients to take time to study the three providers and determine which can provide the doctors a family needs, advises Chris Hemminger, who deals with Medicaid clients at the Erie County Health Department.
April Faley, 43, Vermilion, said she chose Anthem as her Medicaid provider after performing some research.
"I contacted all of my physicians to see if they would take the Anthem," Faley said.
Anthem maintains a directory of doctors who will take Medicaid, but it seems to get out of date pretty quickly, Faley said. Some of the doctors have told her they no longer take Medicaid.
Faley, who wears glasses, said she is searching for an eye doctor who accepts Medicaid patients.
Largely because it accepts Medicaid, the mobile dental clinic at the Erie County Health Department has been a big hit.
When the Dental Center of Northwest Ohio began sending the bus, it stopped in Sandusky twice a month. The Erie County Health Department has persuaded the dental center to schedule at least three visits a month.
"In most cases, there aren't a lot of dentists who are willing to take on new Medicaid clients. There's a lot of paperwork hassles when you talk about having to fill out the Medicaid reimbursement forms," said Mary Dennis, director of Community Health Services at the health department.
Much of the medical care for patients who need to see a primary care doctor is provided by Firelands Medical Center's Family Practice Center.
The center is staffed by physicians in the hospital's Family Practice Residency.
Dr. Brooke Morrison, D.O., 29, a third-year resident, said she was attracted to Firelands' residency program because she liked the people she met in the program.
Morrison said she also welcomed the opportunity to treat indigent patients.
"It helps us to be able to appreciate the kind of struggles people can go through," Morrison said. "We do deal with a lot of issues here."
According to statistics kept by the hospital, 85 percent of the clinic's patients come from Sandusky, with 7 percent coming from Huron and small percentages coming from other communities, including some in nearby counties.
Firelands' Family Practice Clinic has 10,000 active patients on file and is open during the day on weekdays. The hospital has 15 residents and about five supervising physicians; three to four doctors are on duty at any one time, said Dr. Eric Mast, director of the family practice residency.
The waiting list for new patients to be accepted at the clinic is six weeks, "and it could be growing," said Alice Springer, director of development at Firelands.
Medicaid patients who can't get medical care anywhere else can always show up at emergency rooms.
But primary care at the Family Practice Clinic is valuable because it allows patients to come to grips with chronic diseases such as diabetes, said Dr. James Preston, director of medical education at the hospital.
"We get them into counseling," he said. "We give them access to the social services that are in the county."
Average monthly Medicaid enrollment in Erie County
FY 2005 FY 2006 FY 2007
9,684 9,965 6,625 Fee for service
33 58 3,621 HMOs
9,716 10,023 10,246 TOTAL