Are Medicaid dental changes on the horizon? Or will state bite down on existing program?

Dental care, modern clinic, 3d rendering

The state’s Medicaid managed dental care program draws few complaints about the care it provides and users are highly satisfied, a high ranking health care official in the administration of Gov. Ron DeSantis contends.

Still, Florida Medicaid Director Tom Wallace says he would prefer the delivery of health care and dental care not be split between separate managed care programs.

Wallace told members of the House Health and Human Services Committee this week that having beneficiaries enroll in a separate Medicaid dental care plan can cause administrative hassles between the two health plans and can interrupt the overall care provided to Medicaid patients.

“I would say we always like to look at what’s best for the member itself,”  Wallace told members of the committee when Rep. Allison Tant pressed him on the issue. “And to me, if the member can get one care throughout one system, the continuum of care seems to be the best approach.”

But that would require a change in law.

It’s not clear whether the state Agency for Health Care Administration will lobby the Legislature to change how dental benefits are delivered to Medicaid patients in Florida. The agency did not by press time answer Florida Politics’ inquiry as to whether it would propose changes to the dental program in the 2022 Legislative Session that begins in January.

Secretary Simone Marstiller testified last month that the agency would like to make changes to the program so it wouldn’t be required to contract in 11 different Medicaid regions, which also would require legislative approval.

Florida Association of Health Plans President and CEO Audrey Brown told Florida Politics that she has not seen any proposal to change the Medicaid dental benefits or had conversations about the dental benefit with agency or legislative staff. Brown, though, is unapologetic in her belief that oral health and dental care is better provided through the Medicaid managed care program.

“My position will never change,” Brown said in a statement to Florida Politics. “Floridians are best served through coordinated, comprehensive care.“

Florida historically has earned low marks for Medicaid dental care, but the state had slowly been making gains, increasing annual dental visits among Medicaid patients from 34% in 2010 to 43% in 2013.

Performance continued to improve after implementing the mandatory Medicaid managed care program. In 2017, 51% of Medicaid managed care patients had an annual dental visit according to Healthcare Effectiveness Data and Information Set (HEDIS) figures — though it dropped to 50% the next year.

There was a similar trend line for the delivery of preventive dental services to children with the managed care plans making increases in the percentages of children being treated when the state implemented the mandatory Medicaid managed care program. Those gains haven’t continued, Wallace said Tuesday.

He shared data with the committee that shows during the first two years of the Medicaid dental contracts none of the three contracted dental plans met their targeted goals for the delivery of preventive care.

However, customer satisfaction with the plans remains high. Surveys show that Florida Medicaid dental plans earned a score of eight or higher for overall plan satisfaction, quality of care and network of dentists.

Indeed, the plans scored highest for their dental networks with 88% of parents giving the plans a score of eight or above for that category. The data comes from what’s known as Consumer Assessment of Healthcare Providers and Systems (CAHPS) Surveys.

Wallace also noted that the state gets very few complaints from providers

When Florida rolled out its mandatory Medicaid managed medical assistance program in 2014, oral health and dental care was a mandated benefit the plans were required to provide for children. In 2016, MCNA Dental hired former Texas Gov. Rick Perry to lobby then Gov. Rick Scott and earn his support for legislation that carved out dental care from the so-called MMA program and led to separate managed dental plans as of March 2019.

The current Medicaid managed care contracts for both the dental and managed medical assistance program expire in 2024, which means AHCA will begin the lengthy reprocurement process next year. The multiyear contracts are said to be the most lucrative the state puts out to bid. Anticipating challenges, Marstiller is asking lawmakers to appropriate an additional $2 million to her agency in the upcoming fiscal year budget so she can hire outside legal counsel.

There are nearly 5 million people enrolled in Florida’s Medicaid program, most of them in managed care plans.

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.


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