Guest AuthorThe Florida Association of Health Plans (FAHP), which represents billion-dollar HMOs, is pulling a bait-and-switch on the health of Florida’s most vulnerable children. They oppose important legislation designed to protect the oral health of underserved kids.
At issue is roughly $200 million annually in taxpayer dollars that today provide care to kids through the “carved-out” statewide prepaid dental health program.
But as Florida’s mandatory Statewide Medicaid Managed Care (SMMC) goes live, HMOs would rather these dollars flow through them. To help its clients get there, the FAHP omits vital facts and distorts the truth in its appeals to lawmakers.
Just a few months ago, the Agency for Health Care Administration (AHCA) boasted that prepaid dental plans had increased the number of children receiving dental care and the number of dentists participating in the program.
But you wouldn’t know that from the FAHP because they only talk about the achievements of one HMO whose dental program had positive results in one year. Medicaid reform HMOs have been operational for seven years, and for all but one plan in one year, prepaid dental plans demonstrated substantially better results.
Two national prepaid dental plans operate in 62 Florida counties without HMO involvement. The HMOs contracted by the state to administer Medicaid benefits in five “reform counties” subcontract with these same two dental plans to provide care to kids.
But rather than allowing the maximum dollars to flow to children, HMOs take a middleman’s cut. Now, FAHP members want to take a cut of all dental dollars statewide. We are not sure how anyone can suggest this is a good thing.
Children’s dental care is not an expanded benefit under the SMMC; it is mandatory. As SMMC rolls out, HMOs want the children’s dental business because they can subsidize their “free” adult dental benefits — and even other services — with the money they save by keeping use low among children.
In the same breath, FAHP claims that health plans are going to provide adult dental services for “free.” However, if children’s dental funds are kept separate, $100 million in value for adult care would be lost. The two statements are not compatible.
Health plans know this. They know they will have no obligation to promote dental care for children or adults. The fewer people who seek dental care, the more money big HMOs will have on hand to pad their bottom lines. To the contrary, dental care is the only thing that prepaid dental plans do.
Here is the reality we will meet in 2014 if the FAHP has its way: HMOs will continue to subcontract with prepaid plans, taking substantial middleman’s cut in the process, or will cut provider networks and dentists’ pay to the point that use among children will fall back to being dead last in the nation. This is great if you own stock in an HMO, but not so great if you are a child.
In its most overt misstatement, FAHP claims that by preserving the independent prepaid dental plan, Medicaid managed care contracts will need to be reprocured.
To the contrary, AHCA had the foresight to build flexibility into its procurements, specifically allowing for benefit modifications at any time — particularly if state law is changed. AHCA does this routinely.
With the dental community’s support, Senate Bill 340 and House Bill 27 will keep the prepaid dental health program alive. We firmly believe that the Medicaid HMOs will not cancel their health plan contracts with Florida over the precious dollars that would remain separate for children’s dental care.
It is bad public policy to allow health plans to take $200 million out of the mouths of children to pay for a couple of adult cleanings and use the rest for whatever they please.
The prepaid dental program is working for Florida’s children. Let’s not allow the HMOs’ ploy to threaten the health of our children.
