Increasing Access to Dental Care through State Initiatives in Medicaid and SCHIP Diane Brunson, RDH, MPH Director, Oral, Rural, Primary Care Colorado Department of Public Health

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Increasing Access to Dental Carethrough State
Initiatives inMedicaid and SCHIPDiane Brunson,
RDH, MPHDirector, Oral, Rural, Primary
CareColorado Department of Public Health
Environment Texas Oral Health SummitAdvocacy,
Equity AccessAustin, Texas September 9-10,
2004
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Increasing Access

• National Perspectives
• Outreach and Administrative Case Management
• Adequacy of Provider Reimbursement Rates
• Increasing Provider Participation
• Claims processing
• State Perspectives
• Colorado
• Innovations in other states

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Oral Health Crisis

• SG Report Medicaid has not been able to fill
  the gap in providing dental care to poor
  children. Fewer than one in five Medicaid-covered
  children received a single dental visit in a
  recent year-long study period.

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HCFA/CMS Response

• January 18, 2001 Center for Medicaid and State
  Operations, Timothy Westmoreland, Director
• Letter to State Medicaid Directors
• Reviewing HCFA 416 Data ..states are not
  meeting participation goals for pediatric dental
  services..
• TA, Info exchange, and ongoing analysis
• Oversight activities and assessment of state
  compliance with statutory requirements
• 60 days to submit a plan for addressing issues

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In Perspective - 2000

• Children under18 in families above 100 FPL 49
  (MEPS)
• Greater than 200 FPL 56 - 73 (MEPS)
• Medicaid 18 -20
• Focus
• 1st states less than 30
• 2nd states 30 - 50

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Multi-faceted

• Patient/parent education
• Availability of services
• Linking families to services
• Reimbursement rates
• Less than 50 constitutes noncompliance with
  statutory requirements

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Increasing Provider Participation

• Simplification of provider enrollment process
• Rapid confirmation of eligibility at point of
  service
• Mirroring commercial plans admin processes
• Facilitating electronic claims submission
• Reducing PARs
• Establishing a provider hotline
• Using a dental advisory panel to provide guidance
  and field complaints from dental providers

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State Childrens Health Insurance Program

• Similar issues
• Not an entitlement
• Dental was not mandated
• States had choices
• Expand Medicaid
• Mirror federal employees health plan
• Create a new plan

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Colorado
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Colorado

• Commission on Childrens Dental Health
• Nine recommendations
• Five legislative initiatives
• NGA Oral Health Policy Academy
• State Support for Oral Health Programs CDC

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Results

• Dental benefit in SCHIP (CHP)
• RDH as Medicaid providers
• Tax credit
• Dental Loan Repayment
• Infrastructure Grants

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Infrastructure Grants

• 2 million
• 13 grantees
• Comprehensive Primary and Preventive Care Grants
• Foundation grants and initiatives added to
  overall impact

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Dental Loan Repayment

• Federal program funding very few dentists (AHEC)
• NHSC under utilized
• shortage area not a requirement just
  underserved populations
• Over 35,000 Medicaid and SCHIP children receiving
  services
• 24 participants 18 dentists and 6 hygienists

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State Income Tax Creditfor Health Professionals

• Added dental professionals to existing state
  income tax credit program
• Full state income tax credit if
• Live and work in rural area for 3 years
• Outstanding educational loans
• Casualty of current budget deficits

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RDH as Medicaid Providers

• Unsupervised practice hygienists eligible
• Over 50 enrolled as Medicaid providers
• Greater than 2,800 children receiving preventive
  services
• Screening
• Prophylaxis
• Topical fluorides
• Sealants
• OHI

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Dental Benefit SCHIP

• .providing there is an adequate dental
  network
• Dental Network Adequacy Workgroup
• 3 months
• County by county capacity
• Convince SCHIP Advisory Board
• 500 cap on benefits
• Average 440/Medicaid beneficiary
• Pent-up demand

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Dental Benefit in SCHIP

• Delta Dental Plan Colorado (DPO)
• Foundation study adequacy of the benefit CU
  SOD
• 34 eligibles received services
• 10 reached the cap
• Foundation 125,000 to complete care

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Medicaid Analysis
Percent Colorado Medicaid Eligibles Receiving Any
Dental Service by Age Group 5-year Trends
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Wheres the Problem?
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State Initiatives

• American Dental Association
• Don S. Schneider, DDS, MPH
• Enhancing Dental Medicaid Outreach and Care
  Coordination
• Consumer Outreach new and previously enrolled
• (benefit guides, brochures, posters, home
  visits, reminder notices and special mailings)
• Connecting providers to enrollees
• (Geo mapping, hotlines, web pages and
  internet sites)
• www.prnewswire.com/mnr/ada/11207

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State Initiatives

• Obtaining screenings and referrals
• (Physicians provide oral screenings and
  referral dental hygienists in school settings)
• Case Management and Support
• (translation and transportation services,
  member incentive programs local health depts
  providing outreach school-based school
  district subcontracts with dentists)
• Reducing missed appointments
• (Patient responsibility brochures, Medicaid
  liaisons, tracking system)

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Future Initiatives

• State budget woes - HIFA
• Federal legislation
• State Fiscal Relief Act of 2004 (S. 2671)
• Sen. Rockefeller (D-WV), Smith (R-OR) Rep King
  (R-NY), Brown (D-OH)
• Extends Federal Medical Assistance Percentage
  (FMAP)
• 4.8 billion to increase match by 1.26 for next
  15 months

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Future Initiatives

• Federal legislation (cont)
• Childrens Health Protection and Improvement Act
  of 2004 (S. 2759)
• 1.07 billion in federal funds scheduled to
  expire on 9/30/04 and revert, will remain
  available to states
• SCHIP funds no longer have to be reauthorized
  year-to-year, until 2007 when SCHIP is
  reauthorized

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Our Work is Cut Out For Us

• NCSL - Oral Health Policy adopted 7/23/04
• .supports efforts to increase access to
  quality, affordable dental care, including
  initiatives to improve public and private sector
  coverage of dental services, improve oral health
  literacy within the public, and provide states
  flexibility to develop innovative Medicaid dental
  programs to increase access and utilization of
  oral health care services.