Can Medicaid Be Saved?

States push to get dentists and patients onboard.

Despite a history of poor reimbursement, frequent appointment cancellations and general displeasure on both sides of the dental chair, many states are finding ways to make their Medicaid programs thrive, according to an article in the January issue of AGD Impact, the newsmagazine of the Academy of General Dentistry (AGD).

Most general dentists realize that, in addition to the uninsured, Medicaid beneficiaries are often the most in need of dental care. The Surgeon General's report, Oral Health in America (2000), notes that "individuals in families living below the poverty level experience more dental decay than those who are economically better off."

Medicaid matters, but many dentists contend that the system's problems often outweigh the benefits for both patient and doctor. Low reimbursement and patient no-shows are not the only problems GPs have with Medicaid. Prior authorization on too many procedures, poor patient enrollment and utilization, an administrative quagmire that buries providers in paperwork and slow claims processes are ample reasons for many dentists to just say no. A complicated enrollment process and narrow eligibility requirements also has kept patients away, boosting the number of uninsured Americans.

Medicaid is a joint federal-state program that covers more than 47 million people, including 24 million children, 11 million adults and 13 million elderly and disabled people. In fiscal year 2003, combined federal and state payments totaled $247 billion; the program is the largest source of federal funds to the states. Most programs are struggling to find ways to keep providers and beneficiaries in the program, as well as to reach out to dentists wary about committing even as little as 10 percent of their practice to the program.

Medicaid advocates and dental associations say that many states are working hard to make improvements in their programs despite hefty financial burdens. For many programs, the goal is not to merely retain the 30 percent of dentists who participate in Medicaid, but to increase those numbers. To do so requires work on both sides of the Medicaid equation-meeting the demands of patients and doctors.

Several Medicaid administrators are trying to boost provider participation by offering incentives for dentists to join up. Both Delaware and Colorado, for example, offer loan forgiveness for dentists who participate in Medicaid.

To address appointment cancellations, several programs are stepping up their efforts in the area of patient education and provider support. In 2001, Alabama created Targeted Case Management. This program offers transportation services, patient education, cancellation follow-up, and other services. The state also has instituted a public awareness program to emphasize to patients the need to obtain regular dental care.

Arizona's Medicaid administrator, the Arizona Health Care Cost Containment System provides patient services such as transportation assistance, making dental appointments and making a "welcome" phone call to explain the patients' benefits. Arkansas employs direct mailing notices to beneficiaries concerning the importance of appointments and proper office deportment to reduce missed appointments.

"The state of Medicaid has never been terrific, and there are serious issues to address in order to improve the program. [But] there are rays of light, there are states working aggressively to improve upon the program," says Julie Scott Allen, manager of legislative and regulatory policy for the American Dental Association.

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