SUDBURY — The board of health for Public Health Sudbury & Districts (PHSD) is urging the Ontario government to raise reimbursement rates under the Healthy Smiles Ontario (HSO) program, warning that low payments have led to a sharp decline in local dentists accepting referrals.
HSO provides preventive, routine and emergency dental care for children and youth aged 17 and under from income-eligible households. But a recent briefing note to the PHSD board says the program’s reimbursement grid pays far below industry standards — at roughly 40 cents on the dollar compared with the Ontario Dental Association (ODA) Suggested Fee Guide. The ODA says the actual rate is closer to 32 per cent.
Because dentists are not allowed to bill HSO patients for any balance beyond the provincial coverage, many have stopped participating.
“We used to have a referral list, and that referral list actually got down to zero dentists still available on it,” PHSD Medical Officer of Health Dr. Mustafa Hirji told the board at its Feb. 19 meeting. He said dentists treating HSO patients earn less than half of what they would receive from private insurance.
The board passed a motion calling on the province to align HSO reimbursements with the 2026 ODA Suggested Fee Guide for General Practitioners. The goal, the motion states, is to encourage provider participation and improve children’s access to care.
Hirji said the gap has widened in recent years as inflation drove up ODA fee guidelines while provincial payments remained largely unchanged. The last increase to HSO reimbursement was in the late 2000s, according to the ODA.
Board member Natalie Tessier called the situation “shocking,” adding that dental care should be treated as essential health care. PHSD’s briefing note warns that untreated tooth decay can cause pain, disrupt sleep and eating, affect school performance and, in severe cases, lead to life-threatening complications.
PHSD provides dental cleanings for children enrolled in HSO and maintains a referral list for additional treatment. After that list dwindled, the agency surveyed local dental offices last summer.
Of those that responded, 25 per cent said they accept HSO as primary coverage. Another 23 per cent accept patients only when HSO is combined with the federal Canada Dental Care Program (CDCP). The remaining 52 per cent are not accepting HSO referrals.
When combined with HSO, CDCP coverage can bring reimbursement closer to customary fees. On its own, CDCP reimburses about 80 per cent of ODA guidelines, with patients billed for the balance. However, not all families qualify for CDCP, including some newcomers, people who have not filed income taxes and those with minimal private insurance.
Dr. David Brown, president of the Ontario Dental Association, said Ontario’s publicly funded dental programs have the lowest reimbursement rates in Canada. Most provinces reimburse between 70 and 90 per cent of fee guidelines, while the federal CDCP pays about 85.8 per cent.
Brown said dentists have long subsidized provincial programs to maintain access to care, estimating the profession has absorbed at least $150 million annually in Ontario. But he warned that sustainability is now in question as clinics face rising overhead costs.
“The dentist can only do so much over the years,” Brown said, adding that the profession wants children to have access to quality dental care but cannot continue to shoulder the financial burden indefinitely.
The PHSD motion directs its medical officer of health to collaborate with other public health agencies and advocate at the provincial level for improved HSO fees. Board chair will also send a letter to Health Minister Sylvia Jones requesting changes.
“Our hope is to put this on the radar of the provincial government,” Hirji said.