A decade ago, a group of providers sued the state, charging Florida’s Medicaid program shortchanged medical and dental care for kids. Proponents said Medicaid Managed Care was supposed to make it better, but five years into the new system, the legislature is poised to remove dental coverage for kids and roll it into a separate program.
The Florida Department of Health, along with the United Way, goes around to elementary and middle schools, performing routine cleanings and dental sealants for second and sixth graders. That’s when adult molars start coming in. At Tallahassee's Sable Palm Elementary School, the brightly colored furniture of the teachers' break room has been transformed into a dental clinic, where six kids are laying backs down, feet up, as dentists hover over them with a range of hoses, humming machines, and bright lights.
This program is free for kids and its open to everyone--regardless of whether they have insurance. The preventative services are aimed at trying to ward off worse problems down the road. Many of the kids the program serves don’t have regular dental visits, and this may be one of the few times they get treatments.
When Florida transitioned to Medicaid Managed Care several years ago, it also folded in dental services. Providers said they could run health and dental services together, and even boosted some dental benefits for adults. It was a change in the way dental care had historically been provided in the state, says the Florida Dental Association’s Jo Anne Hart. The old system was independent.
“More providers participated, more children received services, and it had an 85-15 percent Medical Loss Ratio which is not currently in the MMA plan. And that’s one of the concerns our dentists are having with the system," she said.
The medical loss ratio, or MLR—mandates how much insurers have to spend on actual services. It disappeared under Medicaid Managed Care. Republican Senator Alan Hays of Umatilla voted for the bill. He’s a retired dentist.
“The prominent rule for dentists not treating Medicaid patients is the extremely low reimbursement rates, and the onerous problems getting the reimbursement," he said. "We need to make sure the reimbursement is required to be as high as it can through the statute, and we need to be giving them adequate fees to see these patients.”
The Florida legislature’s House Bill 819 calls for a study of dental services in Florida’s managed care system. If lawmakers take no action by July of 2017, the program would “carve out” dental by 2019 and revert it to the independent, prepaid system that existed before managed care. The reversion would put the Medical Loss Ratio back in place. But according to a House analysis of the bill, adults could lose some of the additional dental benefits they received in the MMC system.
“Children who are getting their healthcare through Medicaid should be treated like everyone else in Florida," said Sen. Joe Negron, R-Stuart, who sponsored the bill in that chamber. "And the vast majority of Floridians have a dental plan and a healthcare plan for their medical. And we believe that’s best.”
House co-sponsor, Rep. Jose Felix Diaz has been working on the issue since dental was rolled into managed care. “Why are we paying that middle-man fee to the HMO’s to end up contracting with the same prepaid dental providers who were providing care before?”
The measure won bi-partisan and wide support in the legislature and its heading to Governor Rick Scott to approve or veto. The veto campaign is underway, led by the Florida Association of Health Plans. The group claims a move to carve out dental services before the study is evaluated, is “nonsensical.”
“The simple fact is evidence has shown that when Florida’s health plans are in charge of covering pediatric dental services for Florida’s children, more children get the health care they deserve. From the start, FAHP has not been opposed to studying the effectiveness of dental services under the SMMC, but this move to automatically carve out children’s dental services before a study’s findings are evaluated and considered is nonsensical," said FAHP President & CEO Audrey Brown in a letter to Gov. Rick Scott urging him to veto the bill.
But should Scott approve the measure, a big issue remains: funding. Reimbursement rates for Medicaid dentists continue to fall far short of what providers are paid in other states that have been successful with a similar carve out program. Sen. Joe Negron was the architect of the state’s Managed Care system. And he says he plans to continue to address provider payments in the system.
“I agree with you that in order for Florida to get utilization rates like Texas and Connecticut, we’re going to have to increase rates.”
Negron will be Senate President next year. But that doesn’t guarantee he’ll get the funding that he wants. As with most issues in the legislature, nothing is promised.