Improving Medicaid patients access to dental care

1
Improving Medicaid patients access to dental care
2
Vast majority of dental diseases are infectious,
irreversible and destructive.

• 40-year-old male (patient has dental insurance)
  seen by Dr. Mick McCormick (Mauston).

3
Dental diseases can only be diagnosed and
successfully treated with proper intervention by
a licensed dentist and qualified dental staff.

• In Wisconsin, state and federal governments spend
  less than one percent, or just 38 million of
  4.4 billion annual Medicaid (MA) budget, on oral
  health programs for children and adults.
• Four out of five states spend higher percentage
  of MA dollars on dental care for children and
  adults than Wisconsin, according to the American
  Dental Association (ADA).

4
The American Academy of Pediatrics (physicians)
says 20 percent of all health care funds spent on
children should be directed at improving and
maintaining oral health.

• Four-year-old female Green Bay resident treated
  at First Impressions in Wausau due to lack of MA
  providers in her community. Disease so advanced
  pediatric dentist had to treat at Wausau Surgery
  Center under general anesthesia.

5
First Impressions has been committed to seeing
children on MA despite the financial losses this
imposes on the practice.

• Four-year-old female from Green Bay.
• First Impressions is a multi-practitioner
  pediatric dental practice that gets only 40
  percent return on MA billings. (Break-even point
  for most dental offices, not including dentists
  salary, is about 65 cents on the dollar.)

6
Maintaining ones oral health improves overall
health and can help keep health care costs lower.

• 23-year-old female MA patient treated by Dr.
  McCormick early in 2007.
  
• Paying reasonable rates improves a persons
  access to a dental home where he/she can
  receive comprehensive dental care.

7
Death of 12-year-old, low-income boy in
Maryland from a severe brain infection that
spread from an abscessed tooth illustrates that
neglecting dental health can be serious and
costly.

• It was reported a dental extraction costing 80
  accessed early on would have solved the
  12-year-olds problem follow-up medical
  treatment, which unfortunately did not save the
  childs life, cost 250,000. Stories such as this
  are heartbreaking and unacceptable in a society
  such as ours.

8
95 percent of Wisconsins practicing dentists are
small business owners.

• 23-year-old female MA patient treated by Dr.
  McCormick early in 2007.
  
• Small-business owner dentists do not impose a
  hidden tax on private-pay patients by
  cost-shifting losses incurred through
  participation in an inadequately-funded state
  dental MA program.

9
Dr. McCormick billed the states MA program for
one comprehensive oral exam, PAN X-rays, a
three-surface resin filling and surgical removal
of two teeth for a total cost of 919.

• He received a state MA reimbursement check for
  283.65 or just 30.8 percent of the real cost.

10
MA patients experience insufficient access,
because

• of the states lack of commitment to this
  program dentists either limit their MA
  participation or drop their certification.

11
Dental access improves when fair-market rates are
implemented.
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One out of every two WDA practicing dentists
recently answered a questionnaire about dental MA
participation.

• Nearly 80 percent of respondents said they would
  begin seeing or see new MA patients if rates were
  raised to the 75th percentile of the most recent
  ADA fee survey for this region of the country.
• The 50 percent of WDA member dentists who
  responded to the questionnaire alone would see
  approximately 111,400 new MA patients.
  
• 140,000 patients currently receive dental
  services annually under the fee-for-service MA
  program in Wisconsin.

13
The WDA asks the Legislature to prioritize dental
funding within the state budget and increase
dental MA reimbursements to the 75th percentile.

• Four-year-old male MA patient treated by Dr.
  McCormick in 2007.
  
• Increasing rates would cost the state an
  additional 20 - 30 million in General Purpose
  Revenue (GPR) per year.
  
• If approved, the state would still spend less
  than two percent of its entire MA budget on
  dental services.
  

14
Legislators must decide if the states poorest
citizens deserve to have two percent of the MA
budget dedicated to improving their oral health.

• Teenage male patient of Dr. Michael Donohoo
  (Milwaukee) with dental problems caused by
  excessive soft drink consumption.
  
• If legislators are unwilling to prioritize
  funding for dental access within the state
  budget, the WDA proposes fair reimbursement rates
  be provided by implementing a fee on
  distributors, manufacturers and wholesale dealers
  of soda.
• An estimated two cents per 12-ounce can of soda
  Two Cents for Tooth Sense could generate
  approximately 70 million in additional revenue
  each year.

15
Charity is NOT an oral health care system.

• Volunteer data collection shows an individual WDA
  dentist appears to donate 10,000 - 12,000 worth
  of care each year in addition to the free
  services he or she may provide through MA,
  Donated Dental Services, Give Kids A Smile or
  other charitable programs.

16
True oral health prevention requires a
comprehensive approach.

• Professional diagnosis by a dentist
• Regular dental examinations with X-rays
• Necessary restorative and periodontal treatment
  early in the development of dental disease
  
• Regular personal oral hygiene practices
• Observance of a healthy lifestyle and dietary
  habits
  
• Consumption or application of appropriate
  fluoride supplements
  
• Appropriate placement of dental sealants
• Patient education

17
Access to oral health care is a promise
Wisconsin has made to its Medicaid children and
adults.

• It is time for the state to prioritize funding so
  the promise of dental care to Medicaid patients
  can become reality.