Monday, March 7, 2011

Some Good News at Massachusetts’ Medicaid Dental Program

This February, U.S. District Court Justice Rya W. Zobel ended 5-years of court oversight of the MassHealth (Medicaid) dental care program for low-income children.

This is a milestone to celebrate.

In 2005, as the conclusion to a class action lawsuit against the Commonwealth of Massachusetts, Judge Zobel ruled that Massachusetts children covered by the MassHealth dental program encountered “extraordinary difficulty” in obtaining timely dental care, and that the program violated federal Medicaid law. At the time, barely a third of eligible children Massachusetts were being treated by a dentist.

The judge ordered Massachusetts to bring the MassHealth children’s dental program into compliance with federal law and appointed a neutral Monitor, Dr. Catherine Hayes, to make sure the necessary changes were made.

Since then, Massachusetts has made significant improvements to its Medicaid dental program.

1. The state established a full time Medicaid Dental Director. Previously, there was a part-time leader/advocate for oral health.

2. The state hired a 3rd party dental management administrator (DentaQuest) to efficiently manage the processing of claims and to provide provider relations.

3. The Massachusetts legislature increased the fees paid to dentists treating Medicaid patients to a point far more comparable with the cost of providing care. Previously, dentists were reluctant to treat Medicaid patients. In 2009, the Massachusetts Dental Society set a goal to have 65 percent of its membership, including specialists, participate in the MassHealth program by the year 2013. New dentists are joining MassHealth every day.

These changes are making a difference. In 2010, 50% of the children in the program saw a dentist compared to 33% before 2005. So after reviewing the current data, Judge Zobel declared the MassHealth dental program free to function without a guardian.

In Massachusetts, there are other good news events for children’s oral health. School-based programs are now in place across the state, some state-funded and some funded by private philanthropy-- they provide dental examinations including placing dental sealants (thin plastic coatings on molars) and fluoride treatments on children’s teeth to protect against cavities. And, MassHealth is now paying pediatricians and nurse practitioners when they apply fluoride treatments and advise parents and caregivers on how they can help prevent cavities in children.

That’s not to say that there still aren’t oral health challenges in Massachusetts. Benefits are closely tied to the economy and the state’s budget. In 2010, dental benefits for adults in the MassHealth program were cut back. Adult benefits are vulnerable because states are not required to provide them, even though doing so makes good sense. Parents’ dental coverage is a good predictor of whether or not their children will obtain dental services.

Despite economic challenges, more Massachusetts children are getting good preventive dental care, and that’s great news.