You asked (1) for a list of list of state-funded dental clinics and the amount of funding each receives, (2) for the most commonly performed state-funded dental treatments and state spending for them, and (3) how much dental clinics spend on overhead.

SUMMARY

The state pays dental clinics and private practitioners for dental services through three programs: the Department of Social Services (DSS) HUSKY A and B (Medicaid and State Children's Health Insurance Program managed care), Medicaid fee-for-service, and State Administered General Assistance. This report focuses on HUSKY and fee-for-service payments, but because these programs pay differently for services, it is difficult to calculate or obtain the total amount the state pays for dental services.

Connecticut's dental safety net is composed of 65 providers: 19 community and federally qualified health centers (CHCs and FQHCs); 16 hospital and dental school clinics; and 30 school-based health center (SBHCs) sites, some of which offer only limited dental services. According to one source, the state paid 12 CHCs about $ 10. 385 million for dental services to Medicaid clients between July 1, 2004 and June 30, 2006 (it is not clear if this amount is for HUSKY, fee-for-service, or both). Another source reports the state paid all providers, including dentists in private practice, about $ 16. 4 million in 2004 alone.

Most of the dental services provided in 2004 to children enrolled in HUSKY A were for diagnosis and prevention, according to the Connecticut Health Foundation. It reported that these categories accounted for about 75% of all HUSKY-covered dental services provided that year, but only about 45% of HUSKY dental payments.

We were unable to obtain any information specific to dental clinic overhead costs, but several sources suggest that 60 to 65% overhead in a private practice is common and acceptable.

DENTAL CLINIC FUNDING

The state pays dental clinics and private practitioners for dental services through three programs.

1. HUSKY A is a managed care program for Medicaid-eligible children and, in some cases, their parents. Each managed care organization with which the DSS contracts negotiates with the practitioners in its network the amount it pays. DSS recently stated that the managed care organizations pay for dental services at about the same level as DSS pays in its fee-for-service program.

2. The Medicaid fee-for-service program directly pays practitioners for the services they provide to people who are medically needy, that is aged, blind, or disabled. Practitioners receive a rate DSS sets for each service. DSS sets separate rates for adults and children. Adult rates are generally lower than children's rates.

3. The State Administered General Assistance program pays for services to very low-income single people. FQHCs proved the services and are paid under a managed care system.

Since each of these programs pays for services in a different way, it is difficult to calculate and obtain the total amount the state pays for dental services. We asked DSS for data on its payments (1) to each safety net provider and (2) by service type (e. g. , preventive, restorative, orthodontic). DSS has not yet replied; we will forward its response when we receive it.

Connecticut's dental safety net comprises three types of providers: CHCs and FQHCs, SBHCs, and hospitals and dental schools. The Department of Public Health identifies 65 dental safety net providers: 19 CHCs and FQHCs, 16 hospital and dental school clinics, and 30 SBHC sites (some of which offer only limited services). A list of these providers is attached.

A Connecticut Health Foundation (CHF) policy brief stated that the Department of Social Services (DSS) paid about $ 16,361,000 in 2004 for dental services for HUSKY A enrollees in all practice settings (HUSKY A Dental Care: New Directions, 2006). The Connecticut Primary Care Association, a CHC trade group, reported that DSS paid 12 CHCs about $ 10. 385 million for Medicaid dental services between July 1, 2004 and June 30, 2006, according to Evelyn Barnum, its executive director. Barnum did not say whether this amount was for HUSKY A or Medicaid fee-for-service clients.

Private practice dentists provide the majority of services to HUSKY A patients, according to the CHF. It reported, based on Connecticut Voices for Children data, that safety net facilities provided about 35% of the preventive procedures and 31% of the restorative procedures for which Medicaid paid. In contrast, the approximately 200 to 225 private practice dentists who serve HUSKY A patients provided 65% of the preventative and 69% of the restorative treatment such patients received.

FUNDING BY SERVICE TYPE

The CHF estimates that most of the dental services provided to HUSKY A enrollees in 2004 fell into the diagnostic and preventive categories. Table 1 shows the service break down.

Table 1: Dental Services, by type, for HUSKY A Enrollees, 2004

Source: CT Health Foundation, HUSKY A Dental Care: A New Direction, 2006

Although exams and x-rays comprised nearly 40% of all services provided, they and other diagnostic services accounted for only 22% of HUSKY A dental payments according to another CHF report (HUSKY A Dental Care: Financial Strategies, 2006). This analysis of 2004 state spending by type of dental service shows fairly equal payment distribution among diagnostic (22%), preventive (22%), fillings and root canals (26%), and orthodontics (24%). The remaining 6% was spent on nonspecified, “other,” services.

OVERHEAD

We were unable to obtain any information specific to dental clinic overhead costs. Fees in the Medicaid fee-for-service program are far below dentists' customary charges for services, consequently many practitioners, including clinics, argue that they lose money serving these patients. For example, Medicaid pays $ 18 for an oral exam, while 70% of dentists nationally charge up to $ 37 (that is, $ 37 is the 70^th percentile charge). Table 2 shows other comparisons.

Table 2: HUSKY and Customary Dental Fees Compared

Source: CT Health Foundation: HUSKY A Dental Care: Financial Strategies (2006)

Expectations of overhead costs in private practice settings range between 50% and 70% of revenue. A Journal of the American Dental Association article on practice management (February 2000) suggests that while overhead should not exceed 50% of total charges, 60 to 65% is common and acceptable. A 2003 American Dental Association survey found that all expenses other than dentists' compensation comprised 61. 3% of independent dental practice billings. And Dr. Jeanne Strathearn, a Hartford dentist, testified at a recent Public Health Committee hearing that 60% to 65% overhead is typical.

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