W.Va. dental association wary of Medicaid switch

The West Virginia Dental Association (WVDA) is denouncing plans to have HMOs and third-party administrators run the state's Medicaid program for children's dental services, saying it will mean less money for those most in need, according to a story in the State Journal.

State Medicaid officials decided in June to switch from dentists getting paid directly to using three HMOs: Health Plan Administrators, Carelink Health Plans, and UniCare. The HMOs then subcontracted with third-party administrators Scion Dental and DentaQuest to establish a network of dentists willing to provide care for children on Medicaid.

WVDA Executive Director Richard Stevens told DrBicuspid.com the change will no doubt mean less money for dental care for children because it will divert Medicaid funds to private, for-profit companies instead of going directly to dentists.

"This proposed business model where money changes hands two times before it gets to patient care is not a cost-effective model," Stevens said. "There's going to be less money for dental care. That's the bottom line."

John Law, spokesman for the West Virginia Department of Health and Human Resources, which oversees the Medicaid program, said the goal is to provide a better level of care.

"We have had very poor outcomes for dental care," he told DrBicuspid.com. "A determination was made that managed care companies could offer a lot of care coordination that 'fee-for-service' Medicaid could not offer." The three HMOs have managed care for the state's Medicaid clients for the past 15 years, Law added.

Fewer dentists signing up

More than 50% of West Virginia children get their dental care through Medicaid. "This is coming at a time when we all know that West Virginia children miss more days of school because of oral health problems than any other chronic condition," Stevens noted.

Currently, more than 600 West Virginia dentists take Medicaid for children's dental care, but the new network appears to have only about 80 dentists who have signed on so far, according to Stevens.

Part of the reason so few dentists have joined the network are the payment arrangements, he added. The contracts have provisions stipulating that dentists would get paid only after the HMOs and third-party administrators are paid, he said.

Another drawback is that the contracts are "open-ended" and not limited to Medicaid patients, meaning the contracts also could be used for private-payor patients. That is unacceptable to dentists who are already unhappy with the low fees Medicaid pays, Stevens said.

In August, DentaQuest started offering dentists a $500 signing bonus and 5% across-the-board fee increases, Stevens said. He called the monetary incentives "just short of prostituting the profession."

"I think providers don't like managed care, particularly providers who haven't dealt with it before. It's difficult to get dentists to care for Medicaid patients -- period." Law said. "We want to put care around the patient instead of care around the provider."

Because dentists will get paid per patient instead of per procedure, the new system will hopefully treat children before they develop more serious dental problems, Law said. "It will be in the dentists' and company's best interest to get children routine cleanings and routine work because it's cheaper for dentists to keep a child's teeth clean and healthy with preventive care and eliminate more serious procedures."

But the dental association also criticized the fact that the networks won't be required to contract with pediatric dentists. "This is a children's program," Stevens pointed out. Pediatric dentists treat infants, children with disabilities, and kids who may not be good candidates in a general dentist's office."

Implementation delayed

The switch, originally planned for November 1, now has been delayed until January 1, 2011. Stevens attributed the delay to DentaQuest's inability to attract enough dentists to sign up. The Centers for Medicare and Medicaid Services (CMS) has to approve the network to ensure there will be a sufficient number of dentists, he said.

CMS just approved a 33% fee increase for 64 dental procedures, the first increase since 1992, according to Stevens. But the costs of doing business have increased significantly more, he noted.

"This is not a financial bonanza for any dentist," he said. "Dentists won't get rich treating Medicaid patients."

The WVDA recommends contracting directly with a single, experienced vendor, Stevens said. The association also prefers that administration procedures aren't overly burdensome for dentists to comply with.

"Whether it's DentaQuest or another third-party administrator is all right with us as long as they have dental program experience and will keep the network open to all dentists, both general practitioners as well as specialists," he said.

DentaQuest, which also administers the Medicaid program in 24 states and the District of Columbia, was criticized recently for cutting 150 dentists from Idaho's Smiles program, many of them pediatric dentists.

As of press time, DentaQuest had not responded to requests for comment.

Stevens questioned the wisdom of using of tax dollars to pay private sector companies that then use the money for signing bonuses.

"It can only be for one reason in my opinion -- to save money," he said. "They're [West Virginia officials] passing the buck. It's easier."

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