Karen Cyphers: New study provides strong case for keeping children’s Medicaid dental services separate

A new study, reported by the Wall Street Journal and conducted by UnitedHealthcare, suggests that regular dental care improves outcomes and reduces costs for persons with chronic conditions.

Specifically, the study found that people with chronic conditions who received appropriate dental care had net medical and dental claims that were over $1,000 lower per year than for those who did not receive such care, even after accounting for the cost of the dental care itself.  Consider that people with chronic conditions account for more than three-quarters of total health care costs, and the potential for widespread savings become even more apparent.

While the study’s findings are strong, its conclusion is erroneous. The study suggests that employers and payers should integrate dental benefits into health plans; however in practice, state Medicaid programs, along with commercial insurance and state employee insurance programs, have discovered otherwise.

While providing any dental benefit is better than providing none, all evidence points to greater outcomes when dental benefits are offered through dental managed care plans versus through larger health plans.

Multiple states have attempted to integrate dental benefits with Medicaid managed care, but later reversed course and separated dental benefits back out.

Why? Because dental plans have a singular, laser focus on dental benefits, ensuring that maximum benefits are provided.

In contrast, when dental is batched in with health benefits, capitated rates paid for dental services are combined with all other fees, giving no incentive for plans to push for greater dental benefit utilization. Put simply, the importance of oral health gets lost amongst the myriad of medical services the medical plan is responsible for.

Further, most medical managed care plans do not have the expertise necessary to perform the difficult task of assembling fragile dental networks, nor do they have the capacity to deal with the unique problems that arise as a provider of dental care. Therefore, they contract directly with a dental plan.

In other words, why pay a health plan to pay a dental plan when you could pay the dental plan the same amount, resulting in more money being available for actual dental care and not a middle man.

United’s findings should be heeded in terms of states maximizing access to dental benefits. But to get there, paying dental plans directly is the best way to go for patients, for dentists, and for taxpayers.

That’s what Florida’s Medicaid program is currently doing (and with impressive results!) through the prepaid dental health program. But the effort is in danger and improvements will go by the wayside when it sunsets in October 2014.  At that point, dental services under Medicaid will become wrapped into the managed care health plans that cover all other health care services.

It won’t take much to ensure Florida continues boosting access to dental services for children with Medicaid plans.  The Legislature would need to pass a bill extending a sunset of the statewide prepaid dental program to 2017, and Gov. Scott sign it into law.

Most of the action is at the agency level.  By October 31, the Agency for Health Care Administration will be submitting its Waiver implementation plan to federal CMS. In this, AHCA should include the continuation of the separate statewide prepaid dental program as a potential issue that it will face in the implementation of statewide managed care, because there is legislation that continues the prepaid dental program pending now before the Florida Legislature.  Upon legislative approval, AHCA would also submit to CMS a waiver amendment to not include dental within managed care plans as it will continue to be provided via prepaid dental plans.  Finally, ACHA would amend its contracts if necessary with medical managed care plans to remove the dental component from its scope of services and payments.

Most importantly, the prepaid dental program would continue status quo, which means continuing to outperform fee-for-service and medical managed care plans for preventive dental services, and continuing to maximize the number of dentists who open their dental chairs to children enrolled on Florida’s Medicaid program.

The resulting savings will be measured not only in dollars, but in the improved long-term health, school grades, and quality of life for millions of Florida children.