Alabama dentists are seeking emergency funding in the upcoming Medicaid budget, warning that they are “in a crisis situation.”

The Alabama Academy of Pediatric Dentistry is asking legislators for more money, saying current reimbursement rates are causing them to lose money on procedures and struggle to pay staff.

“We continue to lose providers because the reimbursement level is so low that they no longer even meet overhead costs,” said Dr. Keri Miller, a pediatric dentist and president of the state academy. “ I have seen a true access-to-care crisis develop in children’s oral health, and if something does not change it will only get worse.”

Miller, who has practiced in Auburn for nearly 18 years, told AL.com that dentists are being reimbursed roughly 44% less for the same work today than they were in 2010, when accounting for inflation.

She has lost two of her seven dental hygienists in recent months and said she cannot afford to replace them. As a result, she has to see fewer patients and her waiting list continues to grow, she said.

The waitlist for her patients who need surgery is booked until January 2026.

“Often they experience abscesses, pain and lose teeth that could have been saved if their wait time was shorter,” Miller said. “It creates a decreased quality of life for the children of Alabama.”

In a statement to AL.com, Alabama Medicaid said “dental reimbursement rates were increased by Alabama Medicaid inJanuary 2021 and again in June 2023. Alabama Medicaid strives to have open communications with all providers, including dentists, to ensure access to medically necessary services.”

The agency did not comment on whether the dental budget would increase for the upcoming year.

Miller said the last fee increase only amounted to about $3 more per patient.

“We haven’t had a meaningful fee increase in 10 years,” Miller said. “That amount does not cover materials or any overhead. It’s laughable.”

State lawmakers ultimately determine and vote on the final General Fund budget during the legislative session.

For 2025, Alabama Medicaid received the largest line item in the General Fund budget, getting $955 million for the year, a $92 million increase from 2024.

But even with that increase, Miller said dentists did not see any funding changes.

“There are no changes for at least a year and we need emergency funding. They’ve got to figure out a solution because the crisis is not imminent,” Miller said. “It’s here.”

In 2023, Alabama had the nation’s second-lowest ratio of dentists per population, according to the American Dental Association at just 41.6 dentists per 100,000 residents. Alabama narrowly topped Arkansas, which had 41.2 dentists for every 100,000 people.

Both fall far below the national rate of about 60 dentists per 100,000 residents.

Miller said Medicaid reimbursement rates for pediatric dentists are so unsustainable that many dentists have had to stop taking Medicaid patients altogether. Nationally, Republicans in Congress are pushing proposals that could sharply cut funding to Medicaid, and lead to a scale back in state programs.

More than 50% of children in Alabama are on Medicaid.

And according to the Alabama Department of Public Health there is “a growing crisis in oral health among children in the state.” An August 2024 report by the state health department found that nearly a quarter of Alabama’s kindergartners and third graders had untreated tooth decay.

Dr. Barry Burgess, a pediatric dentist in Tuscaloosa, has a practice dedicated to serving Medicaid patients from around the state.

“My patients come to us from 15 different counties here in west Alabama because kids on Medicaid don’t have access anywhere else,” Burgess said. “Recently, we’ve even seen people from Dothan,” a city 200 miles away in southeast Alabama

Burgess has been working with Medicaid patients for over 40 years, but says it’s hard to keep his practice open these days.

He can no longer perform surgeries on children on Medicaid in severe cases because reimbursement rates for hospitals and anesthesiologists are too low.

Pediatric dentists are typically responsible for the care of the kids with the most challenging cases: the youngest with severe early childhood diseases and kids with special healthcare needs.

Dentists often send patients to Children’s Hospital in Birmingham, where the wait time for an operation can reach up to a year.

Without the emergency funding, Burgess fears for both his practice and his patients.

“We can’t do this and lose money, and we’re at a point almost where we’re losing money,” he said. “Access to care is just going away for kids on Medicaid.”