Familia Dental, which last year opened a clinic on Madison’s East Side that mostly treats Medicaid patients, will open another clinic Tuesday on the West Side.
The new clinic, on Gammon Road near Watts Road, will be Familia’s 10th in Wisconsin. The for-profit company, based in Schaumburg, Illinois, has 42 clinics in six states.
Many dentists avoid seeing Medicaid patients, saying Medicaid reimbursements are too low. That makes it hard for many people in the program, also known as BadgerCare in Wisconsin, to find dental care.
Familia says its centralized business model, which includes a single call center for patients and a streamlined billing system, allows it to successfully treat mostly Medicaid patients. The company also accepts private insurance and sees patients without insurance who can pay out of pocket.
Familia is opening a second clinic in Madison because “the need is there,” said Kayvan Azar, a co-founder of the company. “It is one of the most underserved areas in Wisconsin as far as dental coverage for people with low-income, Medicaid.”
The opening of Familia’s new clinic comes as More Smiles Wisconsin, a nonprofit formerly known as the Madison Dental Initiative, plans to open a second clinic in January at the Boys & Girls Club of Dane County’s Allied Family Center in Fitchburg.
More Smiles, which sees patients on Medicaid and without insurance, is considering a third clinic on Madison’s North Side, said Jeff Okazaki, executive director. Its first clinic, at the Salvation Army on East Washington Avenue, opened in 2009.
“There is definitely a significant need within our community,” Okazaki said. “It really is so significant that it’s not something any one organization can take care of.”
Only about 43 percent of Dane County’s nearly 50,000 people on Medicaid saw a dentist in 2014, according to a report last year by Public Health Madison and Dane County.
The next year, in 2015, there were 2,093 visits for dental pain to emergency rooms at SSM Health St. Mary’s, UnityPoint Health-Meriter and UW Health, at a cost of $2.5 million, according to another health department report this year.
“You have people falling through the cracks and ending up in ERs,” said Dr. David Gundersen, president of the Oral Health Coalition of Dane County. “We’re just not getting far enough upstream.”
Gundersen, a dentist at First Choice Dental in Fitchburg, said he doesn’t take Medicaid patients because the rates are too low. He and other First Choice dentists provide some free dental care, however, through programs for the underserved.
Gundersen said the state needs to increase Medicaid payments for dental care, dentists need to take Medicaid patients if rates go up and more financial assistance should be available to help low-income people afford private dental insurance.
In the meantime, providers such as Familia and More Smiles are helping to address the problem, he said. Access Community Health Centers, a federally qualified health center based in Madison, has also expanded its dental services in recent years.
Familia, started in 2008, has clinics in Illinois, Indiana, Iowa, New Mexico and Texas. In Wisconsin, its clinics are in Green Bay, Janesville, Kenosha, Madison, Milwaukee and Racine.
About 60 percent of Familia’s patients are on Medicaid, about 20 percent have private insurance and about 20 percent are uninsured, Azar said.
The clinics offer cleanings, fillings, root canals, dentures and other general dental care, said Brendan Gibney, Familia’s head of corporate development. Many of the clinics also provide orthodontics, though those in Madison do not.
Dentists, instead of dental hygienists, perform the teeth cleanings at most of the clinics, Azar said.
It’s not cost-effective to keep hygienists on staff because some patients don’t show up for cleanings, he said.
Familia opened its first Wisconsin clinic in Milwaukee in 2015. Its East Side Madison clinic, on East Washington Avenue, opened last September.
Azar said the company plans to expand into more states.