Opportunities to Improve the Medicaid Dental Program – Oral Health Watch

By: Diane Oakes, President & CEO of Arcora Foundation

When our state legislators passed the 2019–2021 Operating Budget in the final days of the session, they included a proviso directing the Health Care Authority (HCA) to stop moving forward with the planned implementation of Medicaid dental managed care, to continue directly administering the program under a fee-for-service model, and to issue a legislative report by November 15 which compares the various administrative models and looks at how to increase access to dental care for Medicaid enrollees.

This was an unexpected change of direction, but it presents an opportunity to take the lessons learned from the implementation process, other states’ experiences, and the expertise of our communities to shape a future Medicaid dental program that supports patients and providers and gets us closer to achieving health equity.

Arcora Foundation has submitted research and recommendations to the HCA to help inform their report to the legislature. Our full report is available here.

How the state moves forward with the Medicaid dental program is important. Oral disease is rampant among 20% of Washington’s Head Start children. This means children in pain and unable to learn. Only 9% of Medicaid-insured adults receive preventive care. Oral disease impacts employability and a number of systemic health conditions. Arcora Foundation has partnered with the HCA for more than 20 years to strengthen the Medicaid dental program, increase access to care, prevent oral disease, facilitate the integration of medical and dental care, improve health outcomes and reduce disparities. We remain committed to this work, and we look forward to continued collaboration with the HCA, legislators and other stakeholders.

We recommend three key areas of focus for improving the Medicaid dental program: reduce rates of rampant decay (tooth decay in seven or more teeth) among children of color and other populations experiencing the greatest disease burden, increase oral health access for adults, and increase the emphasis on prevention. In addition to ensuring adequate state investment in the program, we suggest five ways to reach these goals:

  1. Structure the Apple Health Dental Program to be data-informed and outcomes-driven: hire a dental director; engage a third-party convener of stakeholders (such as the Washington Health Alliance), and continue the partnership with Arcora Foundation to compile a comprehensive data report annually.
  2. Update the Benefits Package coverage, reimbursements and structure for children and adults: repurpose and expand the Adult Dental Advisory Committee to provide recommendations for a benefits package update.
  3. Increase the dental network, support providers to increase the number of Medicaid-insured patients they serve and increase the number of enrollees accessing care: partner with Arcora Foundation to expand DentistLink; expand ABCD local coordination resources to engage more providers and reach additional families.
  4. If the state explores a dental carve-in model, it is important to proceed in a way that most likely will lead to success and draws from key considerations learned from other states: include robust requirements in contracts with managed care organizations (MCOs) to ensure they reach oral health goals; encourage the MCOs to collaboratively develop as much consistency as possible in their administrative processes; work with the MCOs to align around a feasible process that enables an adequate portion of total health savings from improved oral health to be reinvested in the dental program; ensure dental stakeholders have a voice in how the program is operated; maximize opportunities for integrated care delivery.
  5. Engage Tribes/Urban Indian Health Programs and Native leaders in a meaningful way to ensure the Medicaid dental program successfully serves Native people: require expertise in Tribal health systems from managed care/administration entities; consult with Tribal/Urban Indian programs prior to making changes that impact their systems of care; be cautious of moving to value-based payment models with Tribal/Urban Indian health programs.

There is more to come as the legislature and HCA make important decisions about the future of the Medicaid dental program. Oral Health Watch will keep readers posted on the HCA’s November report and the 2020 legislative session. In the meantime, we are seeking feedback on your thoughts and suggestions on what will be best for patients, providers and the state as we move forward. Building a stronger Apple Health dental program requires a collaborative, inclusive effort. Please send your ideas, questions or comments to info@arcorafoundation.org.

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