After Minnesota’s Medicaid dental benefits for adults were slashed due to budget cuts in 2009, the state has successfully expanded its adult dental Medicaid benefit set, which will go into effect in the new year.
About one out of four Minnesota residents receive publicly funded dental insurance, and non-traumatic emergency room dental care is estimated to cost $22 million annually. The Minnesota Dental Association (MDA) successfully advocated to expand dental benefits in 2020 and 2022.
This year, House File 898 and Senate File 782, sponsored by Rep. Robert Bierman (D- Apple Valley) and Sen. Liz Boldon (D-Rochester), bills that will restore the adult Medicaid benefit set, were signed into law through the Health and Human Services Omnibus bill.
“The bill had bipartisan support in committee. HF 898 reinstates medically necessary dental care services for MA [Medical Assistance] patients removed during [previous] tight budget years. Reinstatement will result in longer-term savings for the state when we treat conditions early on instead of allowing them to become chronic. Better oral health for many Minnesotans is the immediate and most impactful outcome.”
— Bierman to State of Reform
The 2009 budget cuts led to Minnesota having two different dental benefit sets for Medicaid enrollees, which applied to pregnant adults and pregnant children, and non-pregnant adults. Pregnant adults and pregnant children under the age of 21 experienced extensive benefits, while many Minnesotans enrolled in Medicaid lacked coverage to basic dental services.
Services that are not covered in the state’s adult dental benefit set, but will be covered in the new year, include:
- More than one periodic exam each year
- A detailed and thorough oral evaluation
- A comprehensive periodontal evaluation
- A second annual prophylaxis, or cleaning, appointment
- A second annual topical fluoride treatment
- Crowns
- Additional endodontic treatment, periodontal scaling, and root planing
- Comprehensive prosthodontic treatment, including dentures
HF 1176 and SF 1265 were other third-payer dental-related bills that were included in the larger Commerce Omnibus Bill, which both went into effect on Aug. 1st. State of Reform spoke with Dan Murphy, government affairs manager for MDA, about the impact of this legislation.
Murphy told State of Reform that these bills address three critical aspects of the relationship between dentists and dental plans, like requiring dental plans to provide a fee schedule prior to providers signing contracts. When dentists contemplate new contracts with dental plans, the dental plans were previously not required to share the fee schedule prior to the dentist signing the contract.
These bills also require at least one method of reimbursement provided to dental providers that do not incur fees. Formerly, insurance carriers were able to require dentists to accept claims payments exclusively using a virtual credit card instead of a paper check or direct deposit, with the virtual credit card payment method consisting of a per transaction fee of as much as five percent, which was paid by dentists. The legislation improves transparency and requires dental plans to offer at least one method of reimbursement that does not include a fee.
The final aspect allows for network leasing agreements to be disclosed to dental providers, giving providers an opportunity to opt-out without a penalty. Certain dental plan contracts forced dentists to engage in other third-party payer or managed-care networks without receiving a full disclosure of fees, processing policies, and written consent from the provider, which can oftentimes lead to confusion among patients and providers. The legislation provides an opportunity for dentists to accept or refuse these contracts and opt-out of any network leasing practices without any penalties.
“Overall, the bill will bring fairness and transparency to dental contracting,” Murphy said.