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Medicaid Dental Changes Moving Forward

Agency for Health Care Administration

Florida Medicaid officials are working to start a new dental program that is distinct from the statewide Medicaid managed-care system by March 1, 2019.
To that end, top Medicaid officials told lawmakers Tuesday that the state published its invitation to negotiate — a key step in contracting — for dental services last week and that vendor responses are due by April 16.

Dental care is currently included in the list of services that managed care plans must provide to Medicaid patients. The Legislature in 2016, though, passed a bill over strong objections from the managed-care industry to carve dental services out of the statewide managed-care program.

The bill was sponsored by now-Senate president Joe Negron and was supported by the Florida Dental Association and Fort Lauderdale based MCNA Dental. At the beginning of the 2016 session, former Texas Gov. Rick Perry lobbied Gov. Rick Scott on the bill.

It was a high-profile bill and triggered a power struggle between two well-financed health care interests: the Florida Association of Health Plans and MCNA. Though Scott is a proponent of Medicaid managed care, he signed the bill into law.

While the bill will lead to dental services being provided outside of the statewide managed-care program, Medicaid director Beth Kidder told members of the House Health & Human Services Committee that Medicaid HMOs have improved dental care for patients and that the state wants to ensure that the upward trend continues.

Florida Association of Health Plans President and CEO Audrey Brown issued a statement after Tuesday's meeting noting that Kidder's presentation underscored that Medicaid HMOs have focused on improving care.

“Florida's health plans have continued to work toward improving pediatric dental services and outcomes under the (Medicaid managed care program) both in terms of preventive and annual dental visits, and, we are pleased that the quality scores and measures presented by AHCA (the Agency for Health Care Administration) today reflect that goal,” Brown said in the statement.

HEDIS, or the Healthcare Effectiveness Data and Information Set, is a tool used by more than 90 percent of the country's health plans to measure performance on important dimensions of care and services.

Kidder, deputy secretary for Medicaid at the Agency for Health Care Administration, pointed to improvements in two HEDIS categories since 2015 and 2016, after dental health was a covered benefit provided by Medicaid HMOs.

Kidder said HEDIS scores tracking the number of children who have seen dentists in the last year jumped from 42 percent in 2014 to 49 percent two years later.

“I don't think any of us think 49 percent is where we want to be, but we want to continue this upward trajectory into the future:” Kidder said, noting that the 49 percent is above the national average when compared to other Medicaid HMO plans across the country. She said that the national average is 46 percent.

HEDIS scores in a dental category that tracks children obtaining preventive dental services also have increased. Kidder said the state wants to continue to make the gains in dental health after the changes are made to the program.

Lawmakers asked a number of questions, including about whether the new dental vendors or Medicaid HMOs would be responsible for providing transportation services for patients to dentists.

Kidder, who described dental services as a “tiny sliver” of the costs of the Medicaid program, said the HMOs that provide health care services will continue to be responsible for providing transportation for dental care, if necessary.

Kidder told lawmakers the state doesn't want to have Medicaid beneficiaries confused by more than one transportation option. She said that has been an issue in the Medicaid managed long- term care program, where beneficiaries might see different providers for long-term care needs and other health needs. She said that it has resulted in “lots of questions, concerns, complaints” and said the agency “thought it was better to keep it consolidated in one area.”