GSDM faculty helps Maine abolish wait times for pediatric dentistry patients

One day, pediatric dentist Jonathan Shenkin’s office manager came to him with a problem.

“She [said] we have three new patients in our office—all of them are in pain, and all of them have wait periods,” said Shenkin, who is a clinical associate professor of Health Policy & Health Services Research and Pediatric Dentistry at the Henry M. Goldman School of Dental Medicine (GSDM) in addition to maintaining a private practice in Augusta, Maine.

Wait periods refer to the time—oftentimes months— that an individual must wait between signing up for benefits and being able to use the full coverage. During the waiting period, an insurance company may not pay for certain procedures. In practice, this meant the three new patients waiting in Shenkin’s office that day couldn’t get treatment unless their parents were willing to pay for the entire service.

“Wait periods are something we’ve seen….something that’s been going on my entire career,” said Shenkin “And for some reason, it’s becoming normal to all of us in dentistry.”

These wait periods originated as a way to ensure that adult patients were not just signing up for dental insurance right before a costly procedure, and then dropping the insurance once the procedure was completed. However, wait periods also affect insurance coverage for children, many of whom aren’t enrolled in insurance plans until they visit the dentist for the first time – at which point they may already have cavities.

However, on March 17, 2020, Maine became the first state in the United States to eliminate these wait times for children, when Governor Janet Mills signed bill LD 1975, An Act to Facilitate Dental Treatment for Children, into law. Going forward, this law will enable children with private dental insurance to receive care without having to wait for their coverage to begin.

Shenkin said eliminating wait periods will help dentists provide timely care for patients—and prevent larger issues.

“It just takes a matter of a few months for a small cavity in a baby tooth to explode into something that’s more costly, painful and infectious,” Shenkin said.

Shenkin is a past president of the Maine Dental Association, and has been heavily involved in policy and legislature in his home state. His earlier policy efforts include reducing the availability of soda in public schools and banning smoking in cars with children.

Last year, he contacted Sen. Heather Sanborn, who serves as the chair of the Maine Legislature Committee on Health Coverage, Insurance and Financial Services, regarding ending wait periods for pediatric patients. She agreed to sponsor the bill, which passed in the House on March 5, 2020, and the Senate on March 10, 2020, before being signed into law on March 17, 2020.

Shenkin said that this law will be especially important in the near future, as more and more dental offices reduce practice hours because of COVID-19. The ADA has recommended that dentists nationwide postpone elective procedures in response to the spread of the virus across the country, which means that many patients may be postponing regular check-ups and cleanings.

“Kids aren’t getting the preventative care they need,” Shenkin said. “By putting off treatment as necessary we know that over time dental and periodontal  disease can get more and more significant—and as kids get back into the system, as parents get benefits, and as we get back online….. there’s going to be such a need at the end of this process.”

While Maine is the first state to eliminate wait periods for children, Shenkin said he hoped to see other states follow in their footsteps.

“If you have wait periods—you have a problem,” Shenkin said. “They have to end everywhere, not just in Maine. It’s a national thing that has to unfold for kids.”