ViewPoint A Medicaid solution

For decades, dentist participation in children’s Medicaid has been dismal largely due to anemic reimbursement levels, administrative aggravations and trepidation about patient compliance.

Unfortunately, dentist non-participation has been a major factor in addressing access to oral health care and reducing dental disease for the underserved. Now, thanks to collaborative efforts by Washington Dental Service, Washington Dental Service Foundation and the Washington State Dental Association, we may have a children’s dental Medicaid solution by modeling a highly successful program in Michigan.

Several years ago, with support of the Michigan Dental Association, Michigan’s Department of Community Health formed a public-private partnership with Delta Dental of Michigan to administer dental Medicaid benefits in 21 counties and to reimburse participating dentists at competitive market rates. The program, referred to as Healthy Kids Dental, is now available in 59 of 83 Michigan counties and serves over 200,000 Medicaid enrollees with 91 percent dentist participation. Since its inception eight years ago, the HKD program has seen an increase in the number of dentists participating in caring for Medicaid insured, an increase in the number of children receiving care, a reduction in restorative procedures and a reduction in missed appointments.

Under the proposed plan, the Washington Children’s Dental Medicaid Program would be administered at a break-even rate by WDS using the WDS PPO Network and fees. About 60 percent of Washington dentists participate with the WDS PPO Network vs. less than 30 percent who participate as Medicaid providers. The three-year pilot project would be initiated in 21 counties with demonstrated low-utilization and a shortage of resources. This would include 225,756 children or 32 percent of the Medicaid-insured children in the state with a 20 percent anticipated increase in utilization. Total cost to the state for the three-year pilot project (Phase I) would be $58.7 million. If successful, the program could expand into other counties and, eventually, the entire state.

Most Medicaid fees are about 53 percent of PPO fees and fail to cover even the overhead costs of providing care. The proposal represents a substantial Medicaid fee increase making it affordable for most dentists to participate. Administration by WDS would squelch administrative hassles and, since eligible patients would be issued identification cards similar to other WDS plans, it would help to curb the “Medicaid” stigma. In addition, due to the groundwork laid by the Access to Baby and Child Dentistry (ABCD) Program, concerns about Medicaid patient compliance would likely diminish with time.

Nearly 80 percent of the initial 21 counties included in the proposal and many of their Medicaid families have been involved in the Access to Baby and Child Dentistry Program.

The ABCD Program was started 13 years ago in Spokane as a public-private partnership and has since expanded to 30 of Washington’s 39 counties. ABCD families receive training that includes everything from the value of preventive dentistry to the necessity of keeping appointments and following home care instructions. This education is an asset that can be carried forward to achieve improved outcomes for all future dental Medicaid programs, including the proposed WDS pilot project.

Dentists tend to be a conservative lot and some are against any government involvement in health care鈥攊ncluding Medicaid. But, everyone must admit, Medicaid is not going away and the current dental Medicaid system is broken. The incidence of children’s dental disease in Washington state is higher than across the nation and continuing to rise. Low-income children have even higher rates of dental disease. Much of the disparity relates directly to dentist non-participation in the dental Medicaid program due to barriers created by the program. And we now have a plan to overcome these barriers.

For more than two decades I have participated in a chorus of dentists whining at our state legislators to fix Washington Children’s Dental Medicaid Program and help us resolve a huge part of the access to care issue. It’s time to stop whining, get on board and make a difference.

WSDA and WDS will be in partnership to move this through the legislature and your help is needed for it to be successful. I encourage everyone to e-mail or, better yet, pick up the phone and talk with your legislators. Let them know how important this proposal is to improve access to care for the underserved. Let them know how you look forward to providing a greater positive impact for Washington’s future generations.

Make no mistake鈥攖his is an excellent opportunity to create a children’s dental Medicaid solution that works!

Dr. Phipps is the editor of the WSDA News, the journal of the Washington State Dental Association. His comments, reprinted here with permission, originally appeared in the October 2008 issue of that publication.