A change in the way Medicaid enrollees receive dental benefits is currently making its way through the Florida House of Representatives. House Bill 7047 would carve dental benefits back into the Statewide Medicaid Managed Care (SMMC) program rather than through its current stand-alone program.
Proponents of the bill, such as Florida Association for Health Plans CEO Audrey Brown, believe the change will allow medical health plans to better coordinate dental care for Medicaid recipients. However, the Florida Dental Association (FDA) stands in opposition, saying the transition could be detrimental to both patients and providers.
From 2014-2018, medical managed care plans subcontracted with dental plans to provide services to Medicaid recipients. However in 2016 the Florida Legislature directed the Agency for Health Care Administration (AHCA) to separate dental services into a stand-alone program, which began operation in late 2018-early 2019. AHCA now contracts directly with three dental health plans.
The bill would remove the language that requires AHCA to contract separately with dental plans and revert to including dental services as a minimum benefit under medical managed care plans.
According to FDA Chief Legislative Officer Joe Anne Hart, the change could cause administrative problems for providers. Currently, dental plans are able to directly correspond with AHCA on the aspects of their contracts. Under the bill’s provisions, dental plans would need to discuss changes with their respective medical plans, who would then correspond with AHCA and vice versa.
Hart says that since this would also apply to discussions on patient care, adding medical plans as a middleman would potentially delay care. Additionally, she says that during the upcoming SMMC reprocurement in 2022-2023, if a dental plan is not able to contract with a medical plan in a certain region, patients under the original plan may have to switch providers entirely.
“That could cause confusion for the patients, and it could also cause disruption of services to the patients,” says Hart.
Hart is also concerned about the lack of discussions among policymakers about funding for dental services. Florida has a relatively low reimbursement rate for Medicaid dental services compared to other states. A 2020 analysis from the American Dental Association found that Florida’s Medicaid reimbursement for child dental services was about 42.6% of commercial insurance, compared to the national average of 61.4%. Medicaid reimbursement for adult services was either unavailable or only for emergencies.
While dental providers are able to negotiate Medicaid rates with the dental managed care plans, Hart says there is no language that would prohibit rates from being set even lower than current standards.
Hart also says reimbursement rates have not kept up with inflation, and added that dental offices have incurred additional costs during the pandemic to purchase personal protective equipment.
“[The Medicaid dental program] needs more money, because if you get more money in the program, you’re able to pay more people to participate.”
Hart believes there are other ways to improve access to care without rolling dental benefits back under the medical plans. This includes increasing provider incentive by funding the Dental Student Loan Repayment Program. Under this program, dentists who work in a county health department or community health center would have a portion of their student loans repaid if they become a full-time Medicaid provider.
“[Students from] private dental schools are graduating with over $400,000-$500,000 in student loan debt. [Debt from] the public dental school is about $250,000. They’re not going to go to Quincy. They’re going to go to Miami, to Palm Beach, to get a job to pay their student loans.”
The loan repayment program was first established in 2019 but has lacked significant funding. This year, the Senate appropriated $1.77 million to the program before its budget bill was tabled. The House budget bill, which contains no funding for the program, garnered pushback from the Senate and is currently being referred to a Budget Conference.
Aside from addressing provider reimbursement, Hart also advocated for increasing access to dental care by reinstalling the Children’s Medical Services Network Plan. Under this program, which operated outside of the managed care model, children with special needs who may have required sedation or other circumstances to receive dental care were able to access specialized providers. In the process of creating a stand-alone Medicaid dental plan, the programs ended and restricted access to the specialty providers.
During a hearing for HB 7047, proponents of the bill argued that dental offices had higher Medicaid patient encounters when they were rolled into the medical plans. A November 2021 report from AHCA also supports this claim, but notably shows lower utilization in 2020 due to the pandemic.