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ADA Asks Congress to Strengthen Medicaid Oral Health Programs

Reimbursement rates, administrative barriers and dental community involvement cited

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WASHINGTON, Sept.23, 2008—The American Dental Association (ADA) called on Congress and other stakeholders to work together to get more dentists to participate in Medicaid and help the program provide necessary dental care to vulnerable low-income children.

In testimony provided today to the House Committee on Oversight and Government Reform Subcommittee on Domestic Policy, ADA Vice President Jane Grover, D.D.S., said that the most effective thing Congress and the states can do to help Medicaid provide quality oral health care is to increase reimbursement rates to attract more dentists into the program. In addition, they should address ongoing administrative barriers (such as excessive paperwork), and involve state dental societies and individual dentists as active partners in improving the program.

Dr. Grover, who is the dental director at a federally qualified health center in Michigan, said she is well acquainted with the reasons many private practice dentists do not participate in Medicaid. Currently, she said, many state Medicaid fees are well below what it costs dentists to provide care, a situation that severely limits the program's effectiveness.

In her testimony, Dr. Grover cited Michigan's "Healthy Kids Dental" program for its effectiveness in improving access to oral health care.

"The 'Healthy Kids Dental' program is essentially the same as the private sector Delta Dental plan used by many individuals with coverage provided by their employer in the State of Michigan," Dr. Grover said. "The dentists are paid at a PPO rate, which might be less than the usual rate charged by the dentist but is still widely accepted. The claims processing is identical to the private sector plan, except the beneficiaries have no co-pays and there is no annual maximum. In other words, from the dentist's perspective there is no difference between the 'Healthy Kids Dental' program and the widely accepted Delta Dental private plans."

She noted that the "Healthy Kids" plan—with its improved reimbursement rates—has been a resounding success, with dentist participation shooting up from 25 percent to 80 percent within one year of the program's introduction in 2001. Participation now stands at 90 percent.

The key to the success of "Healthy Kids," Dr. Grover said, is the cooperation between all stakeholders in the state to make it succeed. The Michigan Dental Association, the Michigan Department of Community Health, and Delta Dental of Michigan, Ohio and Indiana joined forces to work with the legislature and the governor to develop and expand the program.

To help states improve their Medicaid programs—and greatly improve dental coverage for low-income children—Congress should pass H.R. 2472, the Essential Oral Health Care Act, Dr. Grover said. This bill is important, she said, because it would provide enhanced federal matching funds if a state is willing to increase Medicaid reimbursement rates, address administrative barriers, and reach out to the dental community.