Partly nervous and partly excited, Lanajah Chase slid into a dentist's chair for the first time this week.
As her mother and two siblings watched, the 9-year-old donned an apron before a technician at Children's Dental Services in northeast Minneapolis took some X-rays.
"This thing is heavy," Lanajah said.
She was instructed her to "open up super big, like an alligator." The girl did as she was told, and within 10 minutes her appointment was done.
She was all smiles after the dentist told her she didn't have any cavities and could come back another time for a full cleaning. Getting through that first appointment was easy. Getting it in the first place wasn't.
Like for many families on Medical Assistance — the state's version of Medicaid — finding dental care is tough. Lanajah's mother, Denise Stone, wanted to get her children into a clinic closer to their New Hope home. But some dentists weren't accepting patients on Medical Assistance or had untenable waits.
"All of the other ones were out booked far, like February of next year," Stone said.
About 655,000 Minnesota children were enrolled in Medicaid, but only 36 percent of them received dental services included in their coverage, according to 2017 statistics. That puts Minnesota noticeably below the national average.
The number of dentists who see children in public programs declined from 2,906 in 2015 to about 2,253 last year, according to the Department of Human Services.
There are several causes, but relatively low reimbursement rates are a key reason.
"For whatever reason, it's been very difficult to get momentum in Minnesota to address our incredibly poor Medical Assistance reimbursement rates," said Sarah Wovcha, executive director for Children's Dental Services.
Advocates for the nonprofit providers are already gearing up to make another case to state lawmakers and Gov.-elect Tim Walz to divert tens of millions more dollars toward childhood dental needs. They know they'll face stiff competition when the Legislature returns to craft a new budget in January, although there's a strong likelihood Minnesota will have a robust surplus.
Meetings with key lawmakers have already begun.
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Wovcha's organization primarily serves children from low-income households or immigrant backgrounds. It has two brick-and-mortar clinics, but also vans that ferry equipment to schools, Head Start centers or clinics for low-income mothers — from southern Minnesota to the Iron Range.
"If we bring the services directly to where low-income kids and families naturally congregate that eliminates the barrier in accessing that care," she said.
With the help of sizable grants — $350,000 from Delta Dental of Minnesota Foundation, $200,000 from Otto Bremer Trust and additional contributions from other donors — the century-old Children's Dental Services was set to break ground Wednesday on an expansion that will add five more chairs to one of its Minneapolis sites.
That might not seem like much, but Wovcha said it means capacity to serve up to 10,000 more patients per year.
"It's unacceptable for a child to be in pain and not be able to be treated," Wovcha said.
She's far from the only one worried about service gaps.
Dr. Michael Helgeson, the chief executive of Apple Tree Dental, said poor oral health can carry broader consequences.
"It has a huge impact on their overall health and well-being, their performance in school and really sets them up for a rocky start and contributes to health disparities," he said.
Apple Tree has seven locations spread around Minnesota that serves 15,000 kids annually but struggles to keep up with demand.
"Having Medicaid coverage does not equal being able to make an appointment," Helgeson said, pointing to one of Apple Tree's sites in Fergus Falls as an example. "We have over a thousand patients on a waiting list up there that we're not able to serve. We're at capacity."