K ENTUCKY Cabinet for Health and Family Services Kentucky Department for Medicaid Services Lisa D. Lee, Commissioner November 20, 2015

2 Medicaid at a Glance 1.3 Million Members Managed Care Delivery System ACA Changes Medicaid Expansion State Based Exchange – kynect Streamlined Eligibility and Enrollment

3 Medicaid Enrollment

4 Expansion Demographics Average age = 38 Evenly distributed between males and females Under 138% of Federal Poverty Level - $16,105 per year Health Status –High Cholesterol –Diabetes –COPD –Asthma –Depression

5 Overview of Selected Preventive Services Relative Increases in number of Medicaid screenings Pre-Expansion (2013) vs. Post-Expansion (2014) Smoking Obesity- Metabolic Cancer Cardio- vascular Dental MH Drug & Alcohol Overall Exams *Based Medicaid Claims Data

6 Adult Preventive Dental Visits % 85,779 More Received Preventive Services

7 Medicaid Paid Dental Services by Category SFY2009SFY2010SFY2011SFY2012SFY2013SFY2014SFY2015 CategoryTotal Spend Checkup/oral Evaluation$9,588,344$11,421,513$12,565,091$8,993,894$10,353,870$11,976,471$13,723,578 Dentures$110,174$99,388$115,992$62,763$41,709$41,652$44,361 Extractions$17,088,917$17,493,869$18,369,086$12,633,457$13,500,062$17,770,223$23,581,249 Gum Treatment/Gingivectomy /Debridement$3,188,629$3,351,197$3,687,230$2,134,566$1,682,975$2,280,412$4,094,162 Other$19,775,079$23,614,684$24,614,556$15,597,318$18,345,909$22,543,234$27,478,381 Preventive/Sealants/Clea nings$15,785,138$19,698,002$21,470,772$16,909,144$21,974,170$23,190,664$24,041,463 Prosthesis$17,163$15,962$15,857$8,991$4,137$2,344$777 Pulp Cap/Root Canal$4,278,946$4,252,226$4,077,407$2,860,812$3,083,581$2,944,465$2,929,443 Restoration/Crowns$5,026,268$5,578,092$6,009,033$4,317,920$5,228,747$5,717,563$6,240,392 Restoration/fillings$27,551,645$30,243,809$30,301,185$22,684,698$26,453,088$28,352,284$33,621,099 Space Maintainers/Retainers$796,420$872,668$907,706$653,071$776,400$714,259$617,649 Xrays/Bitewings/Panora mics$10,569,464$12,563,327$12,886,825$9,487,499$11,618,814$13,514,228$16,224,307 Grand Total$113,776,187$129,204,737$135,020,739$96,344,131$113,063,462$129,047,799$152,596,860

8 Number of Medicaid Members Receiving Dental Services SFYDistinct Member Count (Under Age 19 Only) , , , , , ,171 SFYDistinct Member Count (All Ages) , , , , , ,380

9 SFY 2007SFY 2008 Distinct Members Rcving Dental Service 172,589191,725 Distinct Members Enrolled During Timeframe 466,939482,659 Percent Utilizing37%40% What Happened When Kentucky Raised Dental Rates for Children by 30%?

10 Summary Dental Health is Important to Physical Health Not Everyone has Dental Insurance Medicaid Covers 1.3 Million Members Medicaid Expansion Covers 427,000 People Medicaid Paid $152 Million in Dental Claims in SFY2015 Raising Dental Reimbursement Rates Did Not Appear to Result in a Large Increase in Utilization for Children Policy Changes Impact Services