Since the State of Florida has moved away from a fragmented fee-for-service system of healthcare delivery toward a more holistic approach to care through the Statewide Medicaid Managed Care (SMMC) program, we’ve learned many lessons.
One of the most important is that a coordinated healthcare delivery system that addresses whole-body health leads to more effective, preventative care. That means fewer trips to emergency rooms and that Floridians are healthier.
One key component of whole-body health is dental care, and when the SMMC was implemented, Florida’s health plans were put in charge of delivering pediatric dental services to Florida’s children, which, thus far, has been successful.
In fact, a recent report by the Agency for Health Care Administration (AHCA), which looked at year one of carved-in dental services under the SMMC program, found that 43 percent of children in Florida Medicaid have been seen by a dentist.
Compare these results to when pre-paid dental plans were responsible for providing services, and the Health Policy Institute and the American Dental Association found that dental care use among children in Florida Medicaid over the last decade was a dismal 23 to 26 percent. That was one of the lowest in the nation.
Yet, there are proposals in front of the Florida Legislature, Senate Bill 994, sponsored by Sen. Joe Negron, R-Palm City, and House Bill 819, sponsored by Rep. Jose Diaz, R-Miami, that call for a study on the effectiveness of pediatric dental services under the SMMC program.
The worrisome part, however, is that this legislation also automatically carves out children’s dental services from the SMMC program, unless the Legislature otherwise acts before July 1, 2017, regardless of the study’s findings.
The Florida Association of Health Plans, Inc. (FAHP) does not oppose a study, but we do strongly oppose any automatic move to carve out children’s dental services from the SMMC program before the study’s findings are evaluated and considered.
Making policy changes prior to the completion of the study would simply be premature and make the study irrelevant.
Further illustrating that health plans are better equipped to provide dental services under the SMMC program is the medical loss ratio (MLR) difference between pre-paid dental plans and health plans. Data reported by the two statewide prepaid dental plans to AHCA, who are proponents of this legislation, showed that neither plan met the MLR requirement of 85 percent.
In fact, one dental plan even reported an MLR of 56 percent. Translation: only 56 cents of every dollar went to children’s dental services. Compare that to the 85 percent or greater MLR Florida’s health plans are required to meet.
Moreover, Florida’s health plans have been able to leverage provider networks to also cover adult dental services at no cost to the state and at no detriment to pediatric dental services. FAHP members are also able to provide additional services to Floridians above and beyond what pre-paid dental plans would be able to deliver, such as transportation to and from appointments.
The reality is there has been significant increases in the number of children receiving dental services under the SMMC program and we urge lawmakers to oppose any policy changes that would automatically move to carve dental services out.
Audrey Brown is president & CEO of the Florida Association of Health Plans, Inc. Column courtesy of Context Florida.