Michigan’s Medicaid “Healthy Kids Dental” Program: Assessment of the First Five Years Jed J. Jacobson, D.D.S., M.S., M.P.H. Senior Vice President, Professional Services and Chief Science Officer

Nationally, children on Medicaid are far less likely than their privately-insured counterparts to: – have access to and utilize dental services – have a regular source of dental care or a “dental home” – receive comprehensive follow-up if screened – only 20 to 30% receive any dental care in a year Why?

Reimbursement levels that are perceived as insufficient Administrative Burden – complicated and frequent prior authorizations – delays in payment Excessive number of broken appointments Compliance Healthy Kids Dental addresses two, if not all of these dentist barriers

Collaboration with the MDA Pilot a “privately” administered panel program Based upon the MIChild model In 2000, Michigan initiated the Healthy Kids Dental (HKD) program offering dental coverage to Medicaid- enrolled children in 37 of its 83 counties

Healthy Kids Dental Program Administered by the Delta Dental Plan of Michigan Dentists paid usual Delta fees, same as for any other Delta- insured child Child may use any participating provider Program eligibility based on child’s county of residence

Standard claims administration (same as for all other Delta patients) 100% payment (no patient co-payments) No annual maximum Healthy Kids Dental Program – continued

37 HKD Counties

HKD enrollment by month, January 2001 through December 2005

12-Month Enrollment and Access 34.1% 49.0% 37.4% 50.4% 39.9% 51.4% 41.3% 42.2% 51.4% 53.1%

Michigan Healthy Kids Dental utilization of dental care, 12 month enrollment in calendar year, by age Percent of enrolled receiving dental care Age

Percent of enrolled receiving dental care HKD, Medicaid, and Delta private utilization of dental care, 12 month enrollment in calendar year, by age

Participating Dentists Number of dentists and number of children receiving treatment, by year. YearDentistsChildren treated (Children per dentist) ,714 (31.6) ,032 (35.1) ,856 (37.2) ,058 (38.4) ,027 (38.4)

Travel Distance Year Total HKD providers Average (and Median) Delta travel distance in miles Average (and Median) HKD travel distance in miles (7.6)11.0 (7.5) (7.9)11.4 (7.6) (7.9)11.2 (7.6) (8.1)11.3 (7.6) (8.0)11.1 (7.6)

Travel Distance Year Total HKD providers Average (and Median) Delta travel distance in miles Average (and Median) HKD travel distance in miles (7.6)11.0 (7.5) (7.9)11.4 (7.6) (7.9)11.2 (7.6) (8.1)11.3 (7.6) (8.0)11.1 (7.6)

Dental Home YearPercent of Delta children with two or more preventive visits per year Percent of HKD 12- month enrolled children with two or more visits per year

Procedures per User and Percent of Total Cost YearDiagnostic & Preventive Restorations (41.7)1.45 (38.5) (40.5)1.47 (39.3) (41.4)1.45 (38.8) (42.8)1.42 (36.6) (42.2)1.42 (36.1)

Summary Access to dental care has continued to improve as a result of HKD. More children and an increasing proportion of children received dental services each year. The number of dentists providing care continues to increase.

Summary - continued Children continue to access needed services from local providers close to home. Many HKD children appear to have a dental home and be entering regular recall patterns.

Implications Widely seen as an effective way to dramatically increase access to dental care for children. It has been adopted by the American Dental Association and the American Academy of Pediatric Dentistry as a model program for other states.

Healthy Kids Dental Expansion Effective May 1, 2006, the Michigan Department of Community Health expanded the Healthy Kids Dental. Delta Dental will administer HKD in an additional 22 counties throughout the state! This will increase the total number of counties to 59 of Michigan’s 83 counties. To help finance this expansion, changes were also made to the payment structure in Only 14.2% (12.35% of the General Dentists) opted out of the HKD in 2006.

59 HKD Counties