Idaho Medicaid dentists face major cutbacks

While many states across the U.S. are cutting Medicaid dental benefits as one way to battle their budget crises, Idaho is taking a different tack: DentaQuest, the contractor that administers the Idaho Smiles network, is cutting back on the number of dentists who provide services to Medicaid recipients.

DentaQuest reportedly is opting not to renew the contracts of some 150 dentists who currently provide Medicaid services. Of the 980 dentists in Idaho, approximately 600 take Medicaid patients, according to the Idaho State Dental Association (ISDA) -- a significantly higher rate than the national average. And that, says Quinn Dufurrena, D.D.S., J.D., executive director of the ISDA, is part of the problem.

"In 2007, 62% of Idaho dentists delivered services to Medicaid, compared to 20% to 25% nationally," he told DrBicuspid.com. "For a long time, legislators were telling us that we needed to see more Medicaid patients, so we did. And now, what Dentaquest has done -- and this is their terminology -- they 'statistically profiled' the overutilizers of dental services and eliminated the top 150."

Many of the 150 are pediatric dentists, he added.

"The new contract is supposed to take effect November 1, and unless something changes, a lot of dentists will have to fold up and leave -- especially the pediatric dentists," Dr. Dufurrena said. "For a lot of them, 50% to 75% of their practice is geared toward treating Medicaid children. So this could be a disaster for children in Idaho. Say they cut 150 dentists, and each one of them is seeing 500 kids a year -- that is 75,000 kids with no place to go."

Why is DentaQuest proposing the changes?

"They told me that the last couple of years they didn't make money administering Medicaid," Dr. Dufurrena said. "They said they actually lost millions of dollars because so many dentists are seeing Medicaid patients."

As of press time, DentaQuest had not responded to e-mailed questions regarding Dr. Dufurrena's statements. However, in a statement issued October 5, DentaQuest spokesperson Amy Nelson said, "It is simply too early to be specific about the ultimate size of our dental network, but there clearly are economies of scale that are possible while maintaining access to high-quality dental care. Idahoans on Medicaid can be assured that should they need dental care, it will be available, convenient, and of high quality."

Program expanding

The Idaho Smiles program was implemented in 2007 and currently provides services to approximately 220,000 Medicaid recipients, according to the Idaho Department of Health and Welfare (IDHW). The department has a five-year contract with Blue Cross to oversee the program; in turn, Blue Cross subcontracts with DentaQuest to administer the program to certain populations. The current budget is $40 million, according to Tom Shanahan, public information officer with the IDHW.

In the first year of the program, DentaQuest was responsible for administering the program to 160,000 Medicaid recipients -- the "basic" group, which includes healthy children and adults and pregnant women, according to Shanahan. This fiscal year, DentaQuest will also become responsible for the "advanced" group -- those with developmental disabilities -- while IDHW will continue to administer benefits to individuals age 65 years and older, he noted.

In terms of services, the Idaho Smiles contract calls for patients in urban areas to have access to care within 30 miles of their home (60 miles in rural areas), get a routine checkup within 45 days of calling, and receive emergency care within 24 hours of calling. The IDHW will continue to ensure that the provider network meets these requirements, according to Shanahan.

"Our role at the state is to set standards for access to dentists and for timeliness for getting in for treatment," he said. "DentaQuest gets to set up the provider network the way they want, but they have to meet the standards for access, timeliness, and quality of care. Their network has to be able to meet our standards, and we will monitor this and hold them to it."

Other cutbacks

The IDHW has put together a dental advisory panel to look into the changes made to the Idaho Smiles program. In addition to reducing the number of providers in the network, DentaQuest has also reduced reimbursement rates and plans to change some benefits as well, according to Dr. Dufurrena. The concern is that this may discourage some dentists from renewing their Medicaid contracts.

"They have reduced the reimbursement rates across the board by approximately 10%," he said. "But some dentists have told me that for certain procedures they have cut way more than 10%. I understand these cutbacks, but eliminating the practitioners who were doing what they were supposed to be doing? I understand that you have to allocate resources, but you don't have to do it in such an unethical fashion."

With the contract details still being sorted out, according to Shanahan, Dr. Dufurrena said the dental association has already begun looking into other ways to ensure that Idaho's Medicaid recipients can retain the dental services and access to care they need.

"Most dentists just got their [Idaho Smiles] contracts last Thursday, so we are still trying to work through this," he said. "We have contacted the governor's office and legislators. As a last resort I have looked at other states and how they have dealt with this in the courts, and they have been successful in dealing with it this way if they don't have [enough dentists in] the network."

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