MINNEAPOLIS, MN – The Dental Access Partners (DAP) and Minnesota Dental Association (MDA) shared the following letter with Senator Benson regarding the dental proposals currently being negotiated between Senator Benson, the House, and the Governor’s office.
For over a decade, dental advocates, DHS and some lawmakers have been split on how to address our broken Medicaid dental program. We have repeatedly been told through the years by decision makers that dental advocates need to work out their differences and find compromise in order to get something substantial done for this program. That’s exactly what we did this year. It took weekly meetings since March of 2020 to settle on a set of new policies to solve long standing, well-documented problems with administrative structure, an unethical benefit set, and woefully low reimbursements.
- First, we are very thankful that periodontal coverage was included in both the House and Senate bills. Thank you for understanding the importance of this benefit for the overall health of Minnesotans. We wish the fiscal note would have realized the savings this benefit has shown in other states and for health plans that studied its impact on both health and medical savings for patients with a number of chronic conditions. Adding back this benefit alone will help providers keep patients healthier.
- Second, the lack of transparency and accountability for Medicaid dental reimbursements has been laid out in multiple reports to the Legislature over the years. While the issue of a single administrator is controversial, we believe it is the best approach to ensure that both the legislature and agency have better oversight of a state program that all agree needs to improve. Also, providers would have transparency on their reimbursement rates. Currently, the Department of Human Services contracts with an array of Minnesota based HMOs for medical and dental services with the majority of Minnesota’s PMAP and HMOs under contract with one third-party administrator to process and pay dental claims. This third-party administrator contracts with individual dentists, not clinic systems, and does not currently provide dentists with fee schedules. For management and budget purposes, a dentist or practice must reverse engineer estimates of what they will be paid for covered services obscuring whether they have been paid correctly. Lack of a fee schedule is just one of the barriers that has inhibited provider participation in public programs. We ask that you please consider moving to a single or dual administrator for dental programs.
- Third, is the issue of reimbursements which has been inseparably linked to the savings from entering into a single or dual administrative structure. As you know, Minnesota’s Medicaid dental reimbursements are some of the lowest in the country. Administrative burden and being asked to subsidize thousands of dollars of the cost of care are the main reason providers refuse to participate in the program. Even with the Critical Access Dental (CAD) add-on of 37.5%, reimbursement is less than commercial rates. What’s worse, current rates are based on submitted charges from 1989! The House proposal would rebase these reimbursements to align with this century’s costs. This is essential to expand dental services for all providers, both CAD and non-CAD. Without updated reimbursements, no administrative structure can succeed! This hard won compromise is based on the threat to completely eliminate the CAD program and just put the money into the overall base rate. While many non-CAD providers supported this proposal, the reality is that it would completely undermine current high volume CAD providers. That’s why the House dental package works for both private and non-profit dental providers by both rebasing MA reimbursement rates and retaining a reduced CAD add-on of 20% which will sustain essential organizations until the new value-based dental home reimbursements are in place.
This proposal finally attempts meaningful changes in our Medicaid dental program. It will benefit Minnesotans enrolled in MHCP programs. These rate and administrative changes will be auditable and provide reasonable information to providers, regulators and legislators. The time is now to make these very important changes; anything less are just band-aids for a broken system. We collectively believe that this proposal will allow more dentists in private practice and safety-net clinics to participate which will have a positive impact on access to dental care and improve oral health outcomes.
The Minnesota Dental Association is a statewide professional membership organization representing Minnesota-licensed dentists and dental students, with a membership of over 3,000 dentists.
Dental Access Partners is an advocacy partnership between Apple Tree Dental, Hennepin Healthcare and Community Dental Care – three of Minnesota’s most essential critical access dental providers.
The Minnesota Dental Association is the voice of dentistry in Minnesota, representing practicing dentists. It is committed to the highest standards of oral health and access to care for all Minnesotans. You can learn more at www.mndental.org.