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Association pushes for dental Medicaid improvements

Washington—The Association urged Congress to shore up dental Medicaid for vulnerable low-income children by improving reimbursement rates, addressing administrative barriers and reaching out to the dental community.

"First, get many more dentists into the system, which is the primary focus of this hearing," Dr. Jane Grover, ADA first vice president, told the House Committee on Oversight and Government Reform's subcommittee on domestic policy. "Second, influence the geographic distribution of those dentists to make sure they can serve the Medicaid population in a timely fashion. Third, support other initiatives that strengthen the oral health delivery system."

The subcommittee chair, Rep. Dennis Kucinich (D-Ohio), cited the "positive impact" on dental Medicaid of increased dental reimbursement rates, disease management efforts and unified Medicaid management. "Today we seek to move beyond identifying problems with our pediatric dental program under Medicaid and start identifying the reforms necessary to fix a broken system."

Dr. Grover, the ADA witness, offered Michigan's "Healthy Kids Dental" program as one model of effectiveness in improving oral health access. "(This) is essentially the same as the private sector Delta Dental plan used by many people with coverage provided by their employers," she testified. "Dentists are paid at a PPO (preferred provider organization) rate, which might be less than the usual rate charged but is still widely accepted.

"The claims processing is identical to the private sector plan, except that beneficiaries have no co-pays and there is no annual maximum. From the dentists' perspective there is no difference between the 'Healthy Kids Dental' program and the widely accepted Delta Dental private plans. For patients, the stigma associated with being on Medicaid has been removed. Families cannot be differentiated into Medicaid and non-Medicaid groups.

"The 'Healthy Kids' plan has been a resounding success," Dr. Grover told Congress. "Dentists' participation shot up from 25 percent to 80 percent one year after the program was introduced and now stands at 90 percent."

Other witnesses cited examples of public health collaboration with the tripartite dental profession. The acting director of the federal Medicaid program told the subcommittee that the ADA Board of Trustees "has indicated a willingness" to explore creation of an alliance with the Centers for Medicare & Medicaid Services toward "consensus" on indicators of access improvements.

The Virginia Medicaid director cited "close collaboration with the Virginia Dental Association and the Old Dominion Dental Society" in development of the state "Smiles for Children" program. "We sat down with the leadership of the Virginia Dental Association and heard loud and clear that we needed to make some changes. After getting a clear understanding of the changes that were needed, we created an entirely new dental program and declared that it was a new day for dental in Virginia."

In her testimony and in response to subcommittee member questioning, ADA's Dr. Grover urged passage of pending legislation, the Essential Oral Health Care Act, H.R. 2472, "because the bill provides enhanced federal matching funds if a state is willing to increase Medicaid fees, address administrative barriers and reach out to the dental community."

In addition to holding an elected office in the American Dental Association, Dr. Grover serves as dental director for the Center for Family Health in Jackson, Mich., a federally qualified health center, and was a private practice dentist.