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Access to care difficult to find, but possible

By Chris Clasby

When someone discusses access to anything in reference to individuals with disabilities, we typically think of physical access or barriers like steps or narrow doorways. For individuals with disabilities seeking medical or dental care, the term access could mean finding professionals to provide the care they need.

doctor in white coat and scrubsStudies of this subject confirm that individuals with disabilities are more often denied health and dental care than those without disabilities.

Regulations support people with disabilities

Section 504 of the federal Rehabilitation Act of 1973 was the first law preventing denial of services to any individual receiving federal funding. In 1990 Title III of the Americans with Disabilities Act expanded that requirement to all places providing public accommodations, which includes health and dental care providers.

Providers cannot refuse a patient based on disability, treat a patient with a physical disability in a wheelchair rather than on an exam table or refuse to treat the patient because the office doesn’t have accessible equipment.

Providers also cannot tell patients with a disability that they must have an assistant to receive treatment. Still, however, people with disabilities are sometimes denied treatment due to lack of physical accessibility or accommodations at medical or dental offices.

Medicaid/Medicare patients refused?

The fact that many individuals with disabilities rely on Medicaid and/or Medicare for health coverage can also make it difficult to find a provider. A study by the journal, Health Affairs, found that
69 percent of doctors nationally accept new Medicaid patients, but the percentage varies greatly depending on location. The highest percentage accepted is in Wyoming, where 99 percent of doctors accept new Medicaid patients, and the lowest is New Jersey, where only 40 percent do. That means individuals with disabilities who rely on Medicaid may have difficulty finding doctors to perform even annual exams, depending where they live.

Training needed?

It has also been reported that some health and dental providers have denied services to individuals with disabilities due to the type of disability the individual has. In some cases, dentists have refused
new patients with disabilities for a variety of reasons, including dentists themselves lack the training they think is necessary. Some dentists and other providers simply may not know their legal obligations or not be in compliance with him.

Dentist Dr. Brad Wall, of Missoula, Mont., discussed the issue of professionals refusing new patients on the basis of disability. He hasn’t experienced it in his own practice or witnessed it with other providers, but he has thoughts about why it happens.

He says one potential cause could be that pediatric dentists are better trained to work with individuals with certain disabilities. The training difference could become an issue when an adult with a disability who doesn’t communicate or comprehend well goes to a general dentist. The general dentist simply might not know how to provide the appropriate manner of care necessary for that patient. Although the individual is an adult, a referral to a pediatric dentist might be most appropriate to achieve the best care.

Still, however, Dr. Wall suggested that an adult with a disability should start by seeing a general dentist and then talk openly about the most optimal provider for his or her care.

Find the right medical care

If you have difficulties finding and/or maintaining health or dental care, follow the tips below to optimize your results:

Reimbursement

If a medical or dental provider refuses to accept you as a new patient because your only insurance is Medicaid, clarify with the provider. Legally, they can only refuse patients with disabilities
if all new patients with Medicaid only are being refused.

Communicate openly

Be willing to talk with potential medical or dental providers about your needs and how they can be met. Talking about your disability-related needs can help physicians realize they can provide the care needed.

Know the law

If a health care provider informs you that they cannot provide treatment because the facility isn’t accessible, be sure to inform the provider of the law. Study and/ or refer providers to the Access to Medical Care for Individuals with Mobility Disabilities guide provided by the U.S. Department of Justice: www.ada.gov/medcare_ta.htm
* Encourage providers to improve physical accessibility to and within their offices by informing them of available tax credits and deductions for having done so.

Alternate providers

If you rely on Medicaid only and cannot find an independent health or dental care provider, try to seek care at a community health center. To learn more or find one in your area, see the National Association of Community Health Centers: www.nachc.com

Seek advice

Most likely you’re not the only person with a disability in the area having difficulty finding a health or dental provider. Seek advice from others who have disabilities because sometimes word-of-mouth is the best way to find a solution.

Chris Clasby lives in Missoula, Mont. He is known for his advocacy for people with disabilities. He is an avid hunter and fisherman, and much of his work has centered on helping people with disabilities access the outdoors.

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