Transcript Increasing Access to Dental Care through State Initiatives in Medicaid and SCHIP
Increasing Access to Dental Care through State Initiatives in Medicaid and SCHIP
Diane Brunson, RDH, MPH
Director, Oral, Rural, Primary Care Colorado Department of Public Health & Environment
Texas Oral Health Summit: Advocacy, Equity & Access
Austin, Texas September 9-10, 2004
Increasing Access
National Perspectives
Outreach and Administrative Case Management
Adequacy of Provider Reimbursement Rates
Increasing Provider Participation
Claims processing
State Perspectives
Colorado
Innovations in other states
Oral Health Crisis
SG Report: “Medicaid has not been able to fill the gap in providing dental care to poor children. Fewer than one in five Medicaid-covered children received a single dental visit in a recent year-long study period.”
HCFA/CMS Response
January 18, 2001: Center for Medicaid and State Operations, Timothy Westmoreland, Director
Letter to State Medicaid Directors Reviewing HCFA 416 Data: “..states are not meeting participation goals for pediatric dental services..”
TA, Info exchange, and ongoing analysis
Oversight activities and assessment of state compliance with statutory requirements 60 days to submit a “plan” for addressing issues
60 50 40 30 20 10 0 Utilization
In Perspective - 2000
Medicaid 100-200 FPL 200% + FPL
Children under18 in families above 100% FPL: 49%
(MEPS)
Greater than 200% FPL: 56% - 73%
(MEPS)
Medicaid: 18% -20% Focus: 1 st : states less than 30% 2 nd : states 30% - 50%
Multi-faceted
Patient/parent education
Availability of services
Linking families to services
Reimbursement rates
Less than 50% constitutes “noncompliance” with statutory requirements
Increasing Provider Participation
Simplification of provider enrollment process Rapid confirmation of eligibility at point of service Mirroring commercial plan’s admin processes Facilitating electronic claims submission Reducing PARs Establishing a provider hotline Using a dental advisory panel to provide guidance and field complaints from dental providers
State Children’s Health Insurance Program
Similar issues Not an entitlement Dental was not mandated States had choices
Expand Medicaid Mirror federal employee’s health plan Create a new plan
Colorado
Colorado
Commission on Children’s Dental Health
Nine recommendations
Five legislative initiatives
NGA Oral Health Policy Academy
State Support for Oral Health Programs: CDC
Results
Dental benefit in SCHIP (CHP+)
RDH as Medicaid providers Tax credit Dental Loan Repayment Infrastructure Grants
Infrastructure Grants
$2 million 13 grantees Comprehensive Primary and Preventive Care Grants
Foundation grants and initiatives added to overall impact
Dental Loan Repayment
Federal program funding very few dentists (AHEC)
NHSC under utilized “shortage area” not a requirement; just “underserved populations”
Over 35,000 Medicaid and SCHIP children receiving services
24 participants: 18 dentists and 6 hygienists
State Income Tax Credit for Health Professionals
Added dental professionals to existing state income tax credit program
Full state income tax credit if:
Live and work in rural area for 3 years
Outstanding educational loans
Casualty of current budget deficits
RDH as Medicaid Providers
Unsupervised practice hygienists eligible Over 50% enrolled as Medicaid providers Greater than 2,800 children receiving preventive services
Screening Prophylaxis Topical fluorides Sealants OHI
Dental Benefit SCHIP
“….providing there is an adequate dental network…”
Dental Network Adequacy Workgroup
3 months
County by county capacity
Convince SCHIP Advisory Board
$500 cap on benefits
Average $440/Medicaid beneficiary
Pent-up demand
CO DentalAccess Capacity/ General Population to Dentists August 7, 2001 Sedgwick Mesa Moffat Rio Blanco Garfield Montr ose Delta Routt Eagle Pitkin Gunnison Jackson Larimer Weld Morgan Grand Boulder Gilpin Clear Creek Summit Denver Jefferson Douglas Lake Park Teller Chaffee Adams Arapahoe El Paso Elbert Logan Washington Lincoln Philli ps Kit Carson Cheyenne Yuma Fremont Crowley Kiowa San Miguel Dolores Montezuma Ouray Saguache Custer Hinsdale San Juan Mineral La Plata Archuleta Rio Grande Conejos Alamosa Huerfano Costilla Pueblo Otero Las Animas Bent Prowers Baca General Population/DDS Capacity Available Capacity (0-1700) Limited Capacity (1701 or greater)
Dental Benefit in SCHIP
Delta Dental Plan Colorado (DPO) Foundation: study adequacy of the benefit: CU SOD 34% eligibles received services 10% reached the cap Foundation $125,000 to complete care
Medicaid Analysis
Percent Colorado Medicaid Eligibles Receiving Any Dental Service by Age Group – 5-year Trends <1 yr 1-2 yrs 3-5 yrs 60 50 40 30 20 10 6-9 yrs 10-14 yrs 15-18 yrs 19-20 yrs Overall 0 1999 2000 2001 2002 2003
Where’s the Problem?
40 35 30 25 20 15 10 5 0 <1 yr 1-2 yrs 3-5 yrs 6-9 yrs 10-14 15-18 yrs yrs 19-20 yrs 2001: % Medicaid eligibles receiving any dental service by age
State Initiatives
American Dental Association
Don S. Schneider, DDS, MPH “Enhancing Dental Medicaid Outreach and Care Coordination”
Consumer Outreach: new and previously enrolled (benefit guides, brochures, posters, home visits, reminder notices and special mailings)
Connecting providers to enrollees (Geo mapping, hotlines, web pages and internet sites) www.prnewswire.com/mnr/ada/11207
State Initiatives
Obtaining screenings and referrals (Physicians provide oral screenings and referral; dental hygienists in school settings)
Case Management and Support (translation and transportation services, member incentive programs; local health depts providing outreach; school-based: school district subcontracts with dentists)
Reducing missed appointments (Patient responsibility brochures, Medicaid liaisons, tracking system)
Future Initiatives
State budget woes - HIFA Federal legislation
“State Fiscal Relief Act of 2004” (S. 2671)
Sen. Rockefeller (D-WV), Smith (R-OR); Rep King (R NY), Brown (D-OH) Extends Federal Medical Assistance Percentage (FMAP)
$4.8 billion to increase match by 1.26% for next 15 months
Future Initiatives
Federal legislation (con’t)
“Children’s Health Protection and Improvement Act of 2004 (S. 2759)
$1.07 billion in federal funds scheduled to expire on 9/30/04 and revert, will remain available to states
SCHIP funds no longer have to be reauthorized year-to-year, until 2007 when SCHIP is reauthorized
Our Work is Cut Out For Us
NCSL - Oral Health Policy adopted 7/23/04: “….supports efforts to increase access to quality, affordable dental care, including initiatives to improve public and private sector coverage of dental services, improve oral health literacy within the public, and provide states flexibility to develop innovative Medicaid dental programs to increase access and utilization of oral health care services.”