Photo by George Lauby
Lincoln County will contribute a one-time grant of $36,000 to keep dental services operating at the West Central District Health Department downtown, following action Monday by the Lincoln County Board of Commissioners.Shannon Vanderheiden, the executive director of the health department, told the Bulletin the dental service looks like it will finish the fiscal year budget in arrears by about $65,000, according to the projected budget.
With the help of the commissioners as well as private grants, she hopes to end the fiscal year at break even, June 30.
Vanderheiden is asking the commissioners of the six counties in the west central district to contribute $1 per capita (per person in their county.) That will generate about $39,000, Vanderheiden said, with Lincoln County contributing the vast majority.
The health department provides an array of services and treatments, primarily to low- and moderate-income residents. The department was created in 2001, along with about 20 other health districts around Nebraska. Their establishment was initially funded largely through a financial settlement between the U.S. states and major tobacco companies regarding the harmful health effects of cigarettes.
Dental services were added at the west central health department in 2004 with the help of a six-year federal grant.
Vanderheiden said about 7,000 patients came to the the department for dental care in a recent six month period. Many of them had an emergency. She said outside financial support is limited – state and federal grants are not as plentiful as they once were. Dental patients currently wait months for major treatments.
Eighty-five to 90% of dental patients are on Medicaid, she said, and Medicaid only reimburses about 30% of the costs. She said reimbursement for some procedures does not cover costs.
Vanderheiden said the department intends to change the “payer mix,” increasing the percentage of patients with private insurance coverage to about 30%, instead of the current 10-15%.
It will take time to change the payer mix, she said.
When Commissioner Joe Hewgley asked "how long?" she said the department could make significant progress in six months.
Commissioner Bill Henry, who is on the department’s board of directors, urged the commissioners to grant the request. He said the county has two choices – support the health department, or let its dental services go down the drain.
He said if the health department is not there, patients end up in the hospital’s emergency room.
Hewgley said the first question to answer is if the county can afford to help. He said such dynamics are relatively frequent -- grant money is available to start new programs, but then the grants dry up, throwing the costs to the local taxpayers.
He said if the patients go to the emergency room, they are treated and the hospital might get a pittance of reimbursement from Medicaid, and that is not the county taxpayers' responsibility.
Vanderheiden said in the end the hospital has to raise rates to cover its costs, and the patient often doesn’t get the full treatment.
She said dental services at the health department can operate in the black.
“It is just going to take time to adjust the payer mix,” Vanderheiden reiterated.
Commissioner Duane Deterding wondered aloud where the $36,000 would come from.
Hewgley said the county is very lucky to have someone at the helm of the health department with Vanderheiden’s skills, and if the board approved the request, the county would have to find the money somewhere.
The board approved the one-time contribution, 3-0.
Hewgley asked Vanderheiden to return in six months and report on progress. She agreed.