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 & Environment Texas Oral Health Summit: Advocacy, Equity & Access Austin, Texas September 9-10, 2004

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

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.”

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

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

Multi-faceted  Patient/parent education Availability of services Linking families to services  Reimbursement rates Less than 50% constitutes “noncompliance” with statutory requirements

Increasing Provider Participation  Simplification of provider enrollment process  Rapid confirmation of eligibility at point of service  Mirroring commercial plan’s 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

State Children’s Health Insurance Program  Similar issues  Not an entitlement  Dental was not mandated  States had choices Expand Medicaid Mirror federal employee’s health plan Create a new plan

Colorado

 Commission on Children’s Dental Health  Nine recommendations  Five legislative initiatives  NGA Oral Health Policy Academy  State Support for Oral Health Programs: CDC

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

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

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

State Income Tax Credit for 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

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

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

Access Capacity/ General Population to Dentists August 7, 2001

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

Medicaid Analysis Percent Colorado Medicaid Eligibles Receiving Any Dental Service by Age Group – 5-year Trends

Where’s the Problem?

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)

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)

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

Future Initiatives  Federal legislation (con’t) “Children’s 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

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.”