Guest Author
It is well known that Florida has difficult challenges in delivering oral-health services to low-income children. Yet progress is being made.
Florida’s prepaid “carved out” dental-health plans are able to maximize dollars received from the state and boost provider participation in their networks. They are directly accountable to the state government.
This progress will be interrupted if Medicaid HMOs take over administration of dental services. This is the wrong time to add additional layers at the health-plan level in the administration of Medicaid dental programs.
Rather than offering “integrated” care as health plans like to suggest, dividing dental services up among multiple HMOs will only further fragment networks and care in an already vulnerable system.
True integration of dental and full-body health is a major objective of mine. But simply throwing dollars at health plans is not the way to get there. Far from the intent to “integrate” care, Medicaid health plans will simply outsource and subcontract the provision of dental services to the same prepaid dental plans that operate successfully on their own today.
We need to focus on fixing important issues like raising provider fees, reducing administrative burdens and encouraging more providers to participate.
Simply put, carve-out systems are the best at doing this. In a recent independent analysis of data from all 50 states and D.C., children in states with a dental carve-out fare significantly better than those in states without such a program in terms of accessing dental care.
Specifically, in states with a carve-out, an average of 48 percent of low-income children saw a dentist in 2010 compared with 47 percent in fee-for-service states and just 42 percent in states with a carved-in dental program.
Further, state dental-health grades compiled by the Pew Charitable Trust are higher in states with a carve-out by nearly one whole letter grade than in states with a carved-in Medicaid dental program. States with fee-for-service fall between the two — better than carved-in programs but not quite as well as states with dental carve-outs.
It is clear that the right answer for Florida is not only intuitive, but also backed up by data from across the U.S. Florida’s dental carve-out program is working and should be continued.
Frank A. Catalanotto, DMD, authored this column as a private citizen reflecting his own opinions not necessarily those of any organization. He serves as Chair of the Leadership Council of Oral Health Florida; Vice Chair of the Board of Directors of Oral Health America; and Chair of the Department of Community Dentistry and Behavioral Science at the University of Florida College of Dentistry.
