This Periodic newsletter is edited by Dr. James Phillips who Practices in Jonesboro. He is Board certified in Oral and Maxillofacial Surgery; a Fellow in American Academy of Cosmetic Surgery, and the International College of Dentistry. He is an active member of the American Association of Dental Anesthesia and has served as past President of the Arkansas State Board of Dental Examiners and also as President of the Arkansas State Dental Association (2011-2012).
NEADDS Newsletter
Spring 2016
Arkansas Medicaid
It is amazing to see the progression of information dissemination in the internet age; however, compared to my initial days in practice, the effect is transformational. Who would have thought the NEA District would have a dedicated information portal keeping the area dentists “up to date” on tripartite issues. Thanks April [Dr. April Buffington].
It is a pleasure to be able to add to our initial web presentation with some current information concerning Arkansas Medicaid. First, some well-known history. Medicaid was created in 1965 through the Social Security Act. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Plan was developed for children under the age of 21. This was part of LBJ’s “Great Society” concept. It took 18 years for Medicaid to be available in every state. In 1989 dental services were added through EPSDT. Not every state approves comprehensive dental services for Medicaid; but many do, at least, provide minimal dental care for patients, such as pain relief, some maintenance and preventive services, and early diagnosis. As we all are aware, dental services do not require PCP referral as do other covered services, (Arkansas Medicaid Manual, 172.100)
At the present time, Arkansas Medicaid (including dental) is at a cross road. Arkansas’s response to the Affordable Care Act was to establish the “private option” rather than accept the politically unpopular increase of Medicaid. Currently, the Federal Government pays nearly all of the $1.5 (or so) billion cost; however, beginning in 2017, the state starts assuming about 5% of the cost. This increases to 10% (if the rules do not change) in 2020. Gov. Hutchinson is asking DHS to find savings equal to the increased state share. The dental program is only approximately $125 million of the total – but Medicaid is still the largest payer of dental services in Arkansas. What this all means is that the dental program will, in all likelihood, will see some reduction in current funding levels.
Every Delta Dental provider recently received information concerning changing Medicaid dental to a Delta “managed care” program. This letter was intended to inform the providers of Delta’s interest in providing this service and gauge support for this effort. Currently, there are also several out- of- state management organizations interested in contracting for the dental managed care contract. ASDA has been lobbying DHS to “carve out” the dental program from the Medical management provided by HP. Whoever is awarded the contract will be able to provide for the unique needs of dentistry. It is fairly certain that this change will occur sometime in 2017. So what would Medicaid dental managed care look like for NEA dentist? Although it would certainly be different, wouldn’t be wonderful if it was better?! How about filing claims in a manner similar to other commercial vendors? No, or limited, predeterminations? No more paper claims? Direct deposit for work completed? Elimination of those pesky consultants! It is fairly certain that some patient benefits may be eliminated and/or reduced; dental will see some overall spending reduction, probably starting in 2018.
It is certain that changes are a’coming in the Medicaid program-the consensus is that they are for the better!