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Washington State Dental Association

Should WA Contract Out Medicaid Administration

In the last third of the 2016 Legislative Session, there was a lot of fast-paced talk about the future of dental Medicaid. The discussion started when Delta Dental of Washington inserted language in the supplemental budget to conduct a Request for Proposal Process (RFP) to outsource the administration of the dental Medicaid program to a third party provider. Several discussions ensued between legislators, the Health Care Authority (HCA), insurance carriers and the WSDA. Ultimately, language was included in the budget to explore outsourcing options. Recommendations are to be made to the Governor and the Legislature by December 1 of this year. Senator Randi Becker and Representative Michelle Caldier were instrumental in ensuring the final language included appropriate legislative oversight and stakeholder input.

The cover story of this issue of the WSDA News (Issue 5, April 2016) focuses on how four other states have outsourced the administration of their dental Medicaid. As you will see, outsourcing could be beneficial for Washington’s poor and the dentists who care for them. Then again, if poorly done, it could create even more confusion and headaches. I have questions! So many questions!

My biggest concern is how much a for-profit company will take in administrative fees to run these programs. How will that compare to what it costs us now? What enhancements can they offer? Are the enhancements worth additional expense? 

As a Community Health dentist, I want a straightforward administrative fee and as much money as possible to go directly to patient care. If we focus funding on preventing and curing early dental disease, we could spend less money in emergency rooms and prosthetics, et al. We could have a chance to get on top of this access problem. If we burden the plan with high administrative fees then we really miss a huge opportunity to make a difference for low-income people. 

It is important that we examine why the system does not work. Only four states have lower Medicaid reimbursement rates for adults than Washington state. Washington’s current adult dental Medicaid budget cannot afford to cover two preventive care visits for every Medicaid-eligible adult in our state. If there isn’t enough money for prevention in the current system, how can we build a better system for our adults who need medically complex care without increased reimbursement rates? 

Take a look at Dr. Daniel Polsky from the Wharton School’s ongoing study of why doctors do not take Medicaid. He eloquently states that it is not because we do not “like” treating these patients. It is simply because with low Medicaid fees and difficult billing systems, we cannot afford to stay in business treating Medicaid patients. He has strong and dynamic data to prove it. 

It is important that the new administrator shares the data they gather with the WSDA and other concerned parties. We cannot solve problems blindly. 

The Affordable Care Act has an anti-fraud provision that has provided our state with two Medicaid fraud investigators. I want to be able to see how they use the data and ensure that they interpret fraud correctly and fairly. Interpreting billing codes is not easy and we need more transparency and timely feedback to let our offices know when we may be inadvertently billing incorrectly. 

We must improve billing processes. Every dental office would love clarification of billing codes, streamlined billing processes and timely appeals. Just improving the billing system could help tip some providers to sign up for Medicaid.

On the other hand, could these same metrics be used to leverage us to bill a percentage of Medicaid patients with some sort of mandated subsidy? There are several lessons from other states that we would be wise to learn from.

Accountability in this program should not just be limited to dentists. The HCA, the administrator, dentists and patients should all have some way to give meaningful feedback to change the program without laborious effort. 

These are just a few of many thoughts and questions I have. I am sure you have a lot of questions too. What causes you to be or not to be a Medicaid provider? What would make you reconsider caring for Medicaid patients if you currently do not? We want to know. We need your feedback to be able to prepare for that December 1st deadline. This is a great opportunity to help create a Medicaid program that works for everyone. It could greatly improve the dental health of our states most vulnerable population. Let’s fix this! 

Dr. Mary Jennings, WSDA News editor, welcomes comments and letters from readers. Contact her by email at mjenningsdds@gmail.com

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