Medicaid dental program needs reasonable rates to draw dentists

Published - November, 27, 2006

Medicaid dental program needs reasonable rates to draw dentists

State Sen. Durell Peaden, R-Crestview, astutely summed up the situation with the state's Medicaid dental program: "You can't reform what you're not funding appropriately to begin with."

He's right.

For Gov. Jeb Bush and the Legislature, "reform" too often seems to mean cutting services and putting program management in the hands of private companies that then look to further "reform" the system by carving their profit margin out of what's left.

The problem of too few dentists in the Pensacola Bay Area not accepting Medicaid patients looks pretty simple: The program already pays so little that it costs dentists money to accept them.

"Dentists can't afford to keep their doors open just getting 10 cents on the dollar," Peaden pointed out.

It is fine to talk about the need for dentists to step up to meet social and professional responsibilities, but expecting dentists to lose money in doing so isn't fair. Charity freely given is one thing -- and if nothing else, it is tax deductible. But saving the state money by asking dentists to absorb a loss is something else.

We expect many dentists would be happy to accept Medicaid patients even if it meant not earning as much as they make from their regular patients. Or, if they could at least depend on breaking even.

But running the program by stiffing dentists is not the way. The natural result is for dentists to decline to participate.

Which, frankly, might be the point.

Either way, it marks a significant failure on the part of state government.

The Medicaid dental program is a limited one. It provides basic services that provide relief for problems that, left untreated, can debilitate sufferers and lead to worse problems -- the kind that send people without insurance to emergency rooms, the most costly kind of health care.

For adults, Medicaid covers only dentures and emergencies, such as tooth extractions. Children are offered more services, which is critical. Dental needs ignored in childhood can become lifelong problems.

Medicaid was designed to provide a basic level of health care for a segment of society unlikely to get it elsewhere. They are either unemployed or hold low-paying jobs that don't provide health insurance.

States face large and growing costs for Medicaid, so it is reasonable that they look to limit costs. But making the system unworkable isn't "reform."

Right now, a combination of bare-bones public and private resources are available to serve Medicaid patients. That includes health departments in Escambia and Santa Rosa counties, Sacred Heart Health System, five area dentists who accept children as patients, and the Florida Baptist Convention, which provides visits once a year by a mobile office that offers only extractions.

Bringing reimbursement rates up to a reasonable level should bring needed dentists into the program.

-----------------------------------------------------------------------------------




We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org

Medicaid Spending Sees First Decline

Medicaid spending sees first decline

Posted 11/26/2006 11:09 PM ET

By Dennis Cauchon, USA TODAY

Medicaid spending has declined unexpectedly this year, the first drop since the health program for the poor was created in 1965.

The historic reversal will free up billions of dollars in state budgets. Medicaid has been the fastest-growing expense for states over the past 10 years.

Medicaid spending fell 1.4% in the first nine months of the year compared with the same period a year ago, according to the Bureau of Economic Analysis. The drop was even greater — an unprecedented a 5.4% decline — after adjusting for the rate of health care inflation.

The spending has been reduced by cost-controlling efforts and a shift of some prescription-drug expenses to Medicare, the federal health program for the elderly.

"States have made really aggressive changes in how care is managed in Medicaid," Arizona Medicaid Director Anthony Rodgers said. "Every state has taken a different approach, but the success can be seen almost everywhere."

Medicaid provides health care to 56 million poor Americans. The federal government sets broad rules for the program and pays 57% of the expense. States run the program and pay 43% of the cost.

The program is on track to spend $300 billion in federal and state money in 2006, the Bureau of Economic Analysis reports.

Medicaid is separate from Medicare, which insures 42.5 million elderly and disabled. That program — run entirely by the federal government — will spend about $384 billion this year, up 15.6%.

Some Medicaid savings are the result of shifting costs to the federal government's Medicare program. The new Medicare prescription-drug benefit pays most pharmaceutical costs for 6 million elderly poor who used to have their bills paid by Medicaid. Under the new drug plan, states reimburse Medicare for some money saved, but not all.

This complicated cost shifting between the two programs makes it impossible to know precisely how much Medicaid cost cutting is simply shifting expenses to the federal program. A USA TODAY analysis estimates that Medicaid spending would have been about flat — or down 4% after adjusting for inflation — without the new federal drug benefit.

Substantial Medicaid savings resulted from many small cost-containment policies adopted in recent years. The changes include shifting the elderly from nursing homes to less-costly home health care, cracking down on fraud, refining the management of high-cost patients (such as those with AIDS or hemophilia) and cutting some payments to hospitals and doctors.

"This is a unique event. No doubt about it. And there are lot of reasons for it," said Vic Miller, senior fellow at the Federal Funds Information for States, a research group sponsored by states.

Key examples:

•Ohio spent about 10% less on Medicaid from July through October than a year earlier. The $310 million reduction includes $37 million less paid to nursing homes and $32 million less to hospitals. "It's many things, not one sea change," Ohio Medicaid spokesman Jon Allen said.

•Michigan spent $1 billion less than budgeted and $311 million less than it spent a year earlier.

•New York planned for a 7% spending increase this year but now predicts a 3.8% increase.

Posted 11/26/2006 11:09 PM ET