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Kids win in Connecticut

Southington, Conn.—It's a numbers game in Connecticut but one that dentists and children are winning.

Connecticut used to be a state where most dentists—95 percent—did not participate in the Medicaid program because of poor reimbursement rates, some of the lowest in the nation. It was also a state where only one-third of the children who qualified for Medicaid were receiving care.

IMAGE: Dr. John Mooney, member, ADA Council on Government Affairs
Dr. Mooney

It took a lawsuit, a settlement and some elbow grease from dentists, state legislators and dental officials but now significantly more dentists are seeing Medicaid patients and more children are receiving care. Out of the 2,800 dentists in Connecticut, there are now 1,300 who are Medicaid providers, up from about 150 prior to 2008, said Carol Dingeldey, executive director of the Connecticut State Dental Association. And between 60–70 percent of children enrolled in a Medicaid program are now receiving care, up from around 30 percent before 2008.

"What we're seeing over the course of two years of this lawsuit settlement is basically utilization rates for children getting equal or higher than what you would see for private insurance, which is a tremendous success story," said Dr. John Mooney, former CSDA president and a member of the ADA's Council on Government Affairs. Ms. Dingeldey added that 98 percent of the children using Medicaid have access to at least two providers within 10 miles.

This all started in 2000, when an oral health collaborative group filed a class action lawsuit on behalf of all Connecticut children against the state department of social services for "failing to provide reasonable and adequate access to oral health services furnished by dental providers for the adult and child recipients of the Connecticut ‘Husky A' Medicaid program."

In 2006, the CSDA joined a coalition aimed at settling the lawsuit and enacting Medicaid reform in the state. They encountered pushback from legislators who said even if the state did settle and increase reimbursement rates, dentists wouldn't care enough and wouldn't participate in Medicaid, Ms. Dingeldey said.

Dr. Mooney pledged to the state legislature that the dental association would triple the number of dentists participating in Medicaid if reimbursement rates were increased to the 70th percentile. That meant delivering 400 additional dentists.

IMAGE:  Carol Dingeldey, executive director of the Connecticut State Dental Association
Ms. Dingeldey

"We stuck our neck out there and that meant we had to get to work and make sure we could deliver on that," Ms. Dingeldey said.

At the time, the CSDA was participating in the ADA's State Public Affairs program, which provides money and support to state dental associations developing their legislative agendas and public affairs initiatives. The CSDA's goal was to enhance its stature as the leader and voice of oral health care in Connecticut and prove there were enough dentists to provide the necessary care for children, Ms. Dingeldey said.

The dental association put out a series of print ads and radio public service announcements that put the pressure on legislators by saying a lot of parents have difficult choices, either putting food on the table or sending their kids to the dentist.

"We said it was difficult to get kids into care because the state was not holding up its end of the bargain and providing reasonable reimbursement rates for dentists," Ms. Dingeldey said.

In 2008, the state legislature settled the lawsuit and increased reimbursement rates to the 50th percentile. It wasn't what was initially proposed but CSDA officials felt it was a start.

The state also agreed to separate the dental portion of Medicaid from the medical, making it a less complicated bureaucratic process. It also committed to a case management program that would ensure patients actually went to their appointments and were held accountable if they didn't.

"It really has been fairly hassle free, for the most part, and fairly easy," said Dr. Jonathan Knapp, former CSDA president who is the current vice chair of the ADA Council on Dental Practice. "The only thing I think that has been a little problematic has been an occasional patient or family who can't come in or misses their appointment."

IMAGE: Dr. Jonathon Knapp, vice chair, ADA Council on Dental Practice
Dr. Knapp

In addition to the increased number of dentists participating in Medicaid and the higher number of children seeking care, the CSDA said there is more quality access to care. Nobody has been turned away from an appointment, and in emergencies, children never wait more than 24 hours to be seen in a private dental office, Ms. Dingeldey said.

"All of these measurements are really showing that the Medicaid program in the state is a heck of a lot healthier than it was three years ago," Ms. Dingeldey said.

But it remains to be seen whether the success will continue. The lawsuit settlement has a term of four years and it expires at the end of 2012.

"We were challenged and we did better than the challenge," Dr. Mooney said. "Now the challenge to the legislature is asking whether they are going to keep the fees or are they ever going to raise them again. We showed them we can do it."

Ms. Dingeldey said she isn't sure what the state's future financial commitment will be to dentists and Medicaid children. The state has been spending more money than it originally committed to because of the demand, she said.

"The program is not perfect. There are still a percentage of kids who are not getting care and the CSDA and the Department of Social Services is looking at why kids who can access free care do not. We can only get kids the care if they want the care, if the parents want the care," Ms. Dingeldey said. "We've been very proud of the success that we've had. The commitment of our dentists has far outreached our predictions and it just goes to show that it's a two-way street. Dentists want to do the right thing but they can't shoulder the burden. We have to come to some agreement."