You asked whether any other states use fee schedules as a means to attract and keep more dentists in the Medicaid program. You believe that Connecticut does not use such schedules.

This report focuses primarily on Medicaid-covered children’s dental services since there is a good deal of current research available on the issue. To learn more about Medicaid adult dental services in Connecticut, please see two earlier OLR reports: 99-R-0428 and 2003-R-0831.

SUMMARY

All states appear to use fee schedules to reimburse dental providers when they provide services to their fee-for–service Medicaid patients. But the mere existence of such schedules does not attract providers. Rather, most observers agree that states that have increased the fees in these schedules have been able to attract dental providers to their Medicaid programs. Conversely, many states have seen their numbers of Medicaid dental providers fall because the fees in their schedules have remained stagnant and are often only a small fraction of the actual cost of providing the care. In Connecticut, for example, adult Medicaid fees have not risen in 20 years and children’s fees have been the same for over 10 years.

A recent comprehensive study by the American Dental Association (www. prnewswire. com/mnr/ada/11207/) on dental access for low-income children and surveys by the National Conference of State Legislatures (NCSL) substantiate the widely held perception that many low-income children do not have access to dental care and that low reimbursements by Medicaid (and the State Children’s Health Insurance Program) have contributed to this, although the adequacy of reimbursement is not the only barrier to access. These studies show that Connecticut’s Medicaid reimbursement for children’s dental services has lagged behind most states.

Dental providers who serve children covered by Medicaid managed care plans are typically reimbursed through the capitated monthly payment that states pay these plans to reimburse all of the providers who participate in their provider networks, including dentists. In Connecticut, children and certain adults currently receive their Medicaid coverage through such managed care plans, although the state intends to begin providing such services outside the plans later this year. We believe that many other states also manage their children’s Medicaid-covered dental care. We do not know how participating providers are faring in terms of managed care reimbursements when compared to fee-for-service payments.

CONNECTICUT’S CHILDREN’S MEDICAID DENTAL FEES COMPARED TO OTHER NEW ENGLAND STATES

Table 1 lists several dental procedures and the rates that Connecticut and the other New England states paid for these services in 2002. For nearly all of the procedures, Connecticut provided the lowest reimbursement.

Table 1. Medicaid Fees For Specific Children’s Procedures In Connecticut And Other New England States (Fee-For-Service) (2002)

NR=not reported

Source: State Innovations to Improve Access to Oral Health Care for Low Income Children: A Compendium; ADA (2003, using 2002 survey data)

Table 2 shows how Connecticut’s 2002 Medicaid reimbursement for selected children’s dental procedures compares to prevailing fees charged in 2001 for the same procedures by dentists in the New England region. It shows that for all of these procedures, Connecticut’s Medicaid reimbursement was less than 10% of what general practitioner dentists were charging. It then compares these rankings to similar percentile rankings in states that have been identified as having made recent efforts to improve their reimbursements.

Table 2. Connecticut’s 2002 Medicaid Fees Compared With States That Have Increased Reimbursements (Fee For Service)

Source: ADA Survey (2003, using 2001 survey data)

STATES THAT HAVE ENHANCED DENTAL REIMBURSEMENTS

Although adequate reimbursements alone are probably not enough to attract and keep medicaid dental providers, they are certainly one of the main factors. The ADA survey calls the fee inadequacy a “major impediment” to children’s access to oral health care. In November 2002, the National Governors Association (NGA) identified five states that had raised their children’s dental reimbursement rates based on fees charged by dentists in the private market. They were able to do so to a level that 70% to 85% of dentists considered to be the same as or greater than their usual fee. These states included Alabama, Delaware, Georgia, Michigan, and South Carolina. NGA further reported that the 2001 Missouri legislature mandated that Medicaid reimburse dentists, dental hygienists, and pediatricians who provided fluoride treatments, cleanings, and sealants for Medicaid-eligible children in public health settings at 75% of the usual and customary charge.

In 2001, NCSL surveyed states on their Medicaid and SCHIP dental programs. It reported that nearly half of the 48 states that responded had increased their rates within the previous two years, although the survey did not ascertain the level of increase. In a separate study, Drs. Jim Crall and Burt Edelstein found that only five states—Alabama, Georgia, Indiana, Michigan, and South Carolina—were paying rates that about 75% of dentists would accept.

NCSL also reported on the ways that states had raised rates. For example, in Indiana, the state eliminated several adult dental services and reduced the number of children’s procedures that would be reimbursed regularly. With the savings, the state increased the fee for the remaining preventive and restorative procedures for children. The state’s dental association had requested these changes.

According to NCSL, Wisconsin raised its general dental fees in the mid- to late-1990s to approximately 61% of the statewide average charges. It started paying an additional $ 3. 50 for the 20 dental procedures most frequently performed on children under age 21. Then in 1995, the state rolled these bonuses into further fee increases that applied only to claims for Early and Periodic Services, Diagnosis, and Treatment (EPSDT) services. (Under federal law, states that have Medicaid programs must provide EPSDT services to children, including dental care. ) These new fees were approximately 75% of average charges. Like Indiana, the state paid for these increases by eliminating some adult dental benefits and keeping fees flat for non-EPSDT services.

RC: ts