During the 2017 legislative session, the Legislature passed a budget proviso, Senate Substitute Bill (SSB) 5883, Section 213 (1)(c), which requires the Health Care Authority (HCA) to contract out the administration of the dental Medicaid program.
As directed by the proviso, HCA must contract with at least two licensed health plans or managed health care plans, except in areas where only a single plan is available, to provide carved-out managed care dental services by January 1, 2019.
The budget proviso (SSB 5883, Section 213 (1)(c)) also included language that requires:
- Dental plans that are awarded the contract to absorb all start-up costs associated with moving Washington state’s dental Medicaid program from fee-for-service to managed care and commit to achieving an overall savings to the program based on 2016 fee-for-service experience;
- HCA to ensure savings offered by dental plans is actuarially sound;
- Savings achieved by the dental plans beyond the assumed savings in the enacted budget must be used to increase dental Medicaid provider reimbursement rates; and
- HCA must submit an annual report regarding how the dental plans have met their contractual requirements to the Governor and appropriate legislative committees starting January 2019
The HCA is currently working on the request for proposal (RFP), which is scheduled to be released on May 3, 2018. Following the release of the RFP, plan bids will be due to the HCA by June 29, 2018, and the HCA will announce the apparently successful bidders no later than August 6, 2018.
At this time, there appear to be several interested companies that will bid on the contract. Potential bidders will likely be an array of both dental and medical managed care organizations (MCOs). Because a major factor of being a successful bidder will depend on the bidder’s ability to show a strong provider network, bidders have already started contacting providers, asking them to join their network. EVEN IF YOU ARE NOT CURRENTLY A MEDICAID PROVIDER, YOU WILL PROBABLY BE CONTACTED BY SEVERAL COMPANIES DURING THE NEXT SEVERAL WEEKS.
While the WSDA cannot provide recommendations regarding which network(s) to join, we strongly encourage our members to carefully read the agreements and raise any questions or concerns you may have with either the organization directly or the HCA at firstname.lastname@example.org before signing any provider agreement.
Because the RFP has not yet been released, there is currently a great deal of uncertainty surrounding the transition of the dental Medicaid program. In order to stay informed during this important process, please make sure to regularly check the HCA’s website or wsda.org for updates and related information.
Should you have any questions for the Association, please do not hesitate to contact WSDA’s Director of Government Affairs Mellani McAleenan at email@example.com or WSDA’s Government Affairs Associate Emily Lovell at firstname.lastname@example.org.