Public Health Sudbury: Dentists abandoning underfunded kids’ dental program

Healthy Smiles Ontario compensates dentists so poorly, providing only 32% of the standard fee, more than half of local dentists contacted by PHSD have stopped participating in the program, which is aimed at ensuring children from low-income families can still access quality dental care

With a dwindling number of local dentists accepting referrals, the board of health for Public Health Sudbury & Districts has passed a motion requesting the province increase reimbursement rates for its Healthy Smiles Ontario (HSO) program.

The provincial dental program provides preventative, routine and emergency dental services for children and youth 17 years and under from Ontario households who qualify based on income eligibility requirements.

But a briefing note to the Public Health Sudbury board said HSO’s pay grid for services outlines reimbursement rates that are far below industry standards throughout Ontario, resulting in providers being reimbursed at roughly 40 cents on the dollar — a number which Sudbury.com later learned is actually higher than the actual compensation.

Because of the nature of the program, dentists cannot bill HSO patients for the balance not covered by the provincial program.

The motion passed by the Public Health Sudbury board on Feb. 19 asks the province to increase reimbursement for the HSO program so that they align with the 2026 Ontario Dental Association (ODA) Suggested Fee Guide for General Practitioners.

This is “in order to encourage provider participation in HSO and improve access to care for children.”

“So a dentist who is treating a child under Healthy Smiles Ontario is going to be making less than half of what they would be to be treating someone who’s coming in with private insurance,” Public Health Sudbury medical officer of health Dr. Mustafa Hirji told board members.

“Unfortunately, that means a lot of dentists have stopped seeing children under Healthy Smiles Ontario. We used to have a referral list, and that referral list actually got down to zero dentists still available on it.”

Hirji said he believes the province has limited increases to compensation under the program due to fiscal restraint. “They don’t want to be spending more money,” he said.

Board member Natalie Tessier asked if the reimbursement rate had always been that low, or if it has just been decreasing in relation to ODA fee rates.

“It’s very much the latter,” Hirji answered. “Those rates were closer. They were never at the ODA level, but they were closer. Of course, we’ve had a lot of inflation in recent years, and so that ODA rate has climbed up, and the province has not increased their rate as much.”

Tessier said she’s a “little bit shocked” by the situation. “I’m a firm believer that dental care is health care,” she said.

The briefing note said delayed or untreated tooth decay and infections can be painful, affect concentration and school performance, disrupt eating and sleeping patterns and lead to life-threatening conditions.

Public Health Sudbury offers dental cleaning appointments for children and youth under the HSO program, and maintains a referral list of local dentists for further care.

But with that referral list eventually dwindling to zero, Public Health Sudbury conducted a survey this past summer with local dentists.

Among responding dentists, 25 per cent reported they accept HSO as the primary coverage without supplementation, and another 23 per cent indicated they accept only HSO and the federal Canada Dental Care Program (CDCP) combined coverage.

These offices said they would accept HSO referrals from Public Health Sudbury.

But all remaining offices surveyed (52 per cent) indicated they are not accepting HSO at this time and therefore cannot receive referrals.

As indicated above, it’s possible to co-ordinate HSO coverage with the federal CDCP to provide more coverage. Dental providers are not allowed to bill patients for the balance not covered by the HSO program.

If not combined with HSO, the Canada Dental Care Program reimburses roughly 80 per cent of the Ontario Dental Association fee guidelines, and patients are billed the balance, said Hirji.

However, not all families qualify for CDCP, said Public Health Sudbury, particularly newcomers to Canada, those who have not filed income taxes, or those with minimal private dental insurance.

The Public Health Sudbury board motion also directs the medical officer of health “to engage in both cross-agency collaboration with other local public health agencies and agency-level advocacy to strengthen the case for improved HSO fee scheduling.”

“Our hope out of the motion is really to put this on the radar of the provincial government,” Hirji told Sudbury.com.

“So we’re going to have our board chair send a letter to the Minister of Health advocating that the fee schedule get narrowed, but we’re also hoping to then work with the other 20 local public health agencies in the province, and also engage with some members of our dental community, so we can try and build this advocacy so that the province will increase the fee schedule for Healthy Smiles Ontario.”

In light of the PHSD board motion, Sudbury.com reached out last week to the Ontario Ministry of Health, asking for an interview with Minister Sylvia Jones, but has received no response.

We were able to speak on the matter with Dr. David Brown, president of the Ontario Dental Association.

Brown said the HSO reimbursement rate is actually 32 per cent of ODA guidelines, even lower than what was stated during the Public Health Sudbury meeting. The ODA said the last increase to the reimbursement was in the late 2000s.

There’s also a similar low reimbursement rate when it comes to the dental care plan for those receiving the Ontario Disability Support Program (ODSP), he said.

The ODA said Ontario dental programs have the lowest reimbursement rate in the country, with most provinces reimbursing between 70 per cent to 90 per cent, and the Canadian Dental Care Plan reimbursing at 85.8 per cent.

As for why Ontario hasn’t increased rates, that’s a question for the province, said Brown. One thing that has been helpful, he said, is the co-ordination of the HSO and the provincial CDCP programs. Brown would like to see this become permanent.

These two programs combined do bring reimbursement for dentists “close to the customary fee,” he said.

But he’s concerned for those who don’t qualify. “We want kids to have all the advantages that they can have growing up in a safe, healthy environment and having access to quality dental care, which dentists have been fighting for years,” he said.

The majority of dentists do accept HSO and ODSP-covered patients, but “the challenge is, the dentist can only do so much over the years,” said Brown.

He said dentists are paying overhead to run their offices, and they’re reaching into their own pockets to keep these programs going.

Historically, the ODA estimates that Ontario dentists have subsidized provincial dental programs by at least $150 million a year.

“So sustainability is a concern right now,” Brown said.

Heidi Ulrichsen is Sudbury.com’s assistant editor.