Livingston County has lots of dentist offices. They just don\u2019t do much good for the county\u2019s most vulnerable residents.<\/p>\n
The last dental clinic that accepted Medicaid patients closed suddenly last fall. Bringing more dentists into the community hasn\u2019t filled those gaps.<\/p>\n
\u201cYou can have dentists, but if they don\u2019t take Medicaid, then you can\u2019t help folks who have low socioeconomic status,\u201d Livingston County Public Health Director Jennifer Rodriguez said. \u201cThat\u2019s certainly been a barrier for us.\u201d<\/p>\n
But not the only one. Many of the county\u2019s OB-GYNs have moved to higher-population areas, forcing patients to travel more than a half-hour to Rochester.<\/p>\n
Livingston County\u2019s health care challenges aren\u2019t unique. In fact, the county may be better off than most rural parts of New York state.<\/p>\n
A state report<\/a> released last month studied 16 of New York\u2019s rural counties and found \u201clow rates of health care providers, and an alarming lack of access to basic care in many counties.\u201d Federal budget cuts and other changes codified in the so-called “Big Beautiful Bill” could make expanding coverage even more difficult, according to the report.<\/p>\n \u201cWe probably found or confirmed what many people in rural communities already know, which is that there\u2019s some real challenges in terms of access to care,\u201d State Comptroller Tom DiNapoli, whose office created the report, told the New York Public News Network\u2019s Pat Bradley. \u201cAnd in the context of what\u2019s happening because of actions of the federal government coming out of Washington, what is already a challenging situation is only going to become more challenging.\u201d<\/p>\n One of the counties that the Comptroller\u2019s Office studied was Yates, which is situated squarely between Canandaigua, Seneca and Keuka lakes.<\/p>\n Out of a population of about 25,000, Yates County has four physician assistants and no OB-GYNs or pediatricians.<\/p>\n Other counties studied in the report were located outside the Finger Lakes region. Rural roundtables hosted by the Comptroller\u2019s Office in 2023 found that the Finger Lakes suffered from \u201cprimary care staffing shortages and a severe shortage of dentists that accept Medicaid.\u201d<\/p>\n The Yates County Public Health Department didn\u2019t respond to requests for comment.<\/p>\n Diane Delvin, the director of public health for Wayne County, declined an interview, but wrote in an email that \u201cWayne County is fortunately better off than most of the counties listed in the report.\u201d<\/p>\n Rodriguez said the Livingston County Health Department is trying to do what it can. <\/p>\n The department operates a sexual health clinic that works with SUNY Geneseo students, and it oversees a mental health clinic that sees anyone, regardless of their ability to pay. The mental health clinic sees many patients from neighboring counties, especially Steuben, which has a much smaller county health department.<\/p>\n \u201cWhile the provider ratio is still 640 to 1 in Livingston County versus the New York State average of 260 to 1, we\u2019re still able to help folks through our clinic and open access hours, meaning that they can really come at any time,\u201d Rodriguez said.<\/p>\n Other regional health care providers are trying to bridge the gaps in rural areas. For example, Rochester Regional Health tries to overcome patients\u2019 transportation issues by providing telehealth appointments and transportation services. They also operate a Mobile Mammography Clinic<\/a> that stops in multiple counties throughout the region.<\/p>\n The organization tries to fill provider shortages mostly by hiring primary care doctors and nurse practitioners, according to Ingrid Watkins, who oversees three counties as medical director of primary care for the eastern part of Rochester Regional\u2019s coverage area. A large staff of generalists keeps patients out of the emergency room, she said, and helps fill gaps in pediatrics, gynecology and other areas.<\/p>\n \u201cOur goal is to make sure that everybody has a primary care provider and that they get robust care at primary care offices. And then basically we, as primary care doctors, help coordinate care with specialists,\u201d Watkins said. \u201cA lot of patients who don\u2019t have a primary care doctor end up going to the emergency room, where the emergency room doctors are ending up doing some of the primary care work.\u201d<\/p>\n That is unlikely to improve, as millions of Americans are projected to be kicked off Medicaid<\/a> under provisions of the Big Beautiful Bill.<\/p>\n According to the state Department of Health<\/a>, 27% of rural New Yorkers are enrolled in Medicaid, including 20% to 25% of residents in most Finger Lakes counties.<\/p>\n Asked about Medicaid cuts, Watkins said Rochester Regional Health is figuring out next steps.<\/p>\n \u201cOur goal is to take care of patients, and we just do that in any environment that comes up, so we just have to work with the impacts of (the) legislation,\u201d Watkins said. \u201cWe have whole teams that are working on what that means for us.\u201d<\/p>\n New York state has six rural hospitals that receive a larger portion of their income from Medicaid patients than at least 90% of hospitals nationwide. That includes Newark Wayne Community Hospital, according to data from the University of North Carolina at Chapel Hill\u2019s Sheps Center<\/a> published by a group of U.S. senators. An additional five have experienced three consecutive years of financial losses, including Geneva General Hospital.<\/p>\n \u201cThese Medicaid cuts that are coming down are going to be a challenge, particularly for our rural hospitals, some of which already are at a very tight margin,\u201d DiNapoli said.<\/p>\n