Karen Cyphers: The case for keeping Medicaid’s dental carve-out

Here is a case where lawmakers got it right, and then, just as the measure is starting to work, a new law rips out its teeth.  Kinda, literally.

Florida’s Prepaid Dental Health Plan (PDHP) became operational in Miami-Dade County in 2009, and since that time, scores for annual dental visits by low-income children improved each year.

PDHP plans significantly outperformed fee-for-service plans for preventive dental services, and based on their successes, prepaid dental plans were expanded from the Miami-Dade pilot statewide in December 2012.

According to AHCA, as of June 2013, the two prepaid dental health plans have more dentists in their networks in every region of Florida than fee-for-service, by a tune of at least 700.

Considering Florida’s starting point (dead last in the nation for all measures of public dental access) this is a big, consequential deal.

But the effort is already in danger and improvements will go by the wayside when the prepaid dental program 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.

Why does it matter for Florida to contract directly with dental managed care plans for dental services?

When dental benefits are left to health insurers (who in the private market have no interest in offering these benefits, and don’t) state capitated payments for dental care are added to the same giant pot as all other health care services. Where, in that type of system, does an insurer see the incentive to draw in more claims under dental? It doesn’t.

In other words, when dental is mixed into Medicaid health plans, dental services become just one more expendable chip under an insurer’s unified medical loss ratio,  to be distributed into whatever corners of care the insurer feels fit.

In contrast, by contracting directly with dental managed care programs,  each dollar dedicated to oral health care is used for just that.

In Florida and elsewhere, this approach works.

Take Virginia, for example.  When the state moved to an independent dental managed care environment, participating providers increased by 153 percent, and the number of children who utilized dental services increased from 24 to 43 percent.

Likewise, in Maryland, provider participation increased by 75 percent following the start of its program in 2009, and their dental access rate for children is currently 54 percent, well above the national average of 38 percent.

But we don’t have to look must past Miami-Dade to justify a dental carve-out.  The model was created by the Legislature to improve dental access and combat fraud and abuse, and it does just that.

Under prepaid dental in Miami-Dade, access scores increased by 19 percent, and provider satisfaction increased by 22 percent over one year.

This program, and the children it serves, deserve more time to build on this success, and the fix is simple.

The Legislature should extend the statewide prepaid dental managed care program for at least three more years, during which time a full review can take place to validate the improvements we have finally started to see.

By doing so, Florida can avoid the fate it is heading for, and one that many other states have faced. Other states have tied dental care into overall health plans only to have go back later, remove dental, and return these services to their own ‘carved-out’ managed care environment.

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.