By Andrew Oreffice, contributing writer

March 22, 2017 -- A flurry of activity in Washington, D.C. -- including efforts to repeal and replace the Patient Protection and Affordable Care Act (ACA) and proposed changes to how Medicaid funding is allocated -- has the healthcare industry in a state of flux. As dental leaders brace for potentially sweeping changes to the Medicaid program, many are wondering how Medicaid dentistry will fare.

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Andrew Oreffice
Andrew Oreffice is senior vice president of compliance and government relations at Benevis Practice Services.

President Donald Trump calls his appointments to U.S. government healthcare leadership positions "the dream team that will transform our healthcare system for the benefit of all Americans." At the helm of the U.S. Department of Health and Human Services is Secretary Tom Price, MD, a staunch opponent of the ACA. Leading the Centers for Medicare and Medicaid Services is Seema Verma, best known for designing Vice President Michael Pence's Indiana Medicaid expansion model.

Meanwhile, Trump and House Speaker Paul Ryan (R-WI) have come out of the blocks vigorously defending the unveiled plan to repeal the ACA, which expanded Medicaid access to 15.7 million Americans.

While both supporters and the opposition are loudly voicing their opinions, what happens next?

For the 64 million people covered under Medicaid -- and the providers who serve them -- that's the $545 billion question. For those of you wondering, $545 billion was Medicare's total spending in 2015.

Examining the impact on dental coverage

Here's what we do know: Children's dental services are among the essential healthcare benefits under the ACA. Further, the Children's Health Insurance Program (CHIP) guarantees dental care to 8 million more kids in working poor families. And now, under Trump, the ACA is on the chopping block and CHIP's future is uncertain.

Of course, there's much we don't know, and, without a crystal ball, it's impossible to foresee with complete clarity. But based on a few key assumptions, the outcomes for Medicaid dentistry could actually be positive.

“Medicaid dental providers are facing a potentially seismic change at both the state and federal levels.”

First, we're optimistic Congress will reauthorize CHIP, a successful program that has historically enjoyed bipartisan support. With ACA repeal-and-replace efforts underway, eliminating CHIP now would create a gaping hole in children's coverage that nothing else could fill. This program gives states considerable latitude to design streamlined eligibility and enrollment systems. It's also a program that works: A large body of research shows CHIP has improved dental access, utilization, and quality of care.

Additionally, CHIP's legislative authority doesn't expire until 2019, and it's a relatively miniscule part of the overall healthcare budget. In short, CHIP is a smart investment and we believe both sides of the aisle will agree.

Another element of the Medicaid transformation conversation is the prospect of block grants or per-capita cap grants, which would authorize set amounts of money by state or enrollment. Here, too, there could be a bright side for dental practices and patients.

Either plan would allow states to streamline programs, make processes more efficient, and potentially expand access. Meanwhile, as the lead architect of Indiana's Medicaid expansion model, Verma has a successful track record of challenging the Medicaid status quo with consumer-driven design. Through her Healthy Indiana Plan 2.0, a series of incentives and consequences encourages members to engage in their healthcare decisions and plan management.

Under Trump, the potential for success across stakeholders is there. Now, it's a matter of seeing how it all unfolds.

Charting the right course

At Benevis, our position is to advocate for dental care access, particularly for the underserved. When a child on Medicaid goes to the dentist at an early age and begins a lifetime of good oral health, it's is a win/win scenario. Children win by avoiding preventable oral health issues that cost days in school, lead to more serious health issues, and impact self-esteem. Taxpayers win because these children consume less government-funded dental care throughout their lives.

And those are scenarios we all can rally around.

Right now, Medicaid dental providers are facing a potentially seismic change at both the state and federal levels, but it doesn't mean we should veer off course in our efforts to improve dental access for underserved kids across the nation. In fact, it means now is the exactly the right time to stay engaged, focused, and committed to the cause.

Andrew Oreffice is senior vice president of compliance and government relations at Benevis Practice Services.

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

This article is eligible for CE credit. Learn more here.
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Copyright © 2017

Last Updated hh 3/21/2017 3:23:17 PM

3 comments so far ...
3/22/2017 6:40:40 PM
Buckeye DDS
I do not agree with Mr. Oreffice's assessment of the future for the Dental Medicaid program.  I have 41 years of dealing with dental Medicaid in my home state of Ohio.  Unless we can get adult dental to be a mandated service, not an optional service, we will continue to have no clout with our legislature when the next budget crisis hits our state legislature.  We had to take a large cut to save our adult program to already dismal fees when Taft was governor & the Ohio economy tanked back in 2005.  It has been 18 years since we have had a meaningful fee adjustment to keep up with inflation.  When fees were last adjusted on 01-01-2000, the majority of us who treat Medicaid patients felt the fees were fair and adequate to run a dental practice.  Fees would have to double to just put us back to where we were on Y2K and that is not going to happen.  I can tell you that at best I break even at current reimbursement rates and on some procedures I am loosing money.  I am sending more & more difficult procedures down the street including surgical extractions, all root canal therapy & uncooperative pediatric patients.   My practice is half fee for service & half Medicaid.  My fee for service patients are carrying my money losing Medicaid patients.  It is almost impossible to find specialists who will accept Medicaid fee reimbursements in Ohio.   
My office & equipment was paid for 20 years ago & I left dental school with no debt.   There is no way a young graduate can open an office & treat Medicaid patients in my state & make a living at current fee levels.  
If the Federal government switches to a block grant system, adult dental will be the first service to go (because it is an optional service).   I am not optimistic about the future of dentistry under any new Medicaid budget in the present political climate.  
We as professionals know that the majority of dental disease is preventable in non smokers with good diets & proper oral hygiene.  When you treat the Medicaid population we are also battling socio-economic related problems such as a high incidence of smoking, bad diets with huge empty caloric intake causing tooth decay & obesity, drug abuse, mental illness, lack of dental education (they are only baby teeth, my teeth went bad when I was pregnant, all my relatives had dentures by the time they were 40).  Medicaid does not make the patient take responsibility for maintaining their own health.
Glad I am close to retirement.  I see no future in treating Medicaid Dental patients.

3/23/2017 4:52:39 AM
Buckeye the problem is the model. Fee for service is broken period. Medicaid ffs and commercial/private ffs. You made a statement that is the heart of this problem which is why I zeroed in. In your mind Medicaid is not fee for service. In your mind you think the commercial private market is fee for service because they pay close to or full fee. The idea I'm pointing out is that how much is paid relative to the UCR is irrelevant. The model of having to do something or what you believe has to be done is the flaw of our system of healthcare not just adult Medicaid dentistry. Our entire 3 trillion dollar healthcare system has been brainwashed into more and more expensive is better. That logic is erroneous to the concept of science and human evolution. We've been brainwashed that doing things to people makes them better. You even alluded that there is some mystical thing we put into people who are already healthy themselves. I'm a pediatric dentist. The parents on a daily basis in my office are told that these "prophy" cups have no magic. It wears off in 3 days. The varnish I tell them is to repair the damage of the pumice. I tell them the 6 month appointment has no prevention but to see you and explain the rules of the road. I tell everyone if they are looking for magic this ain't the place. The reason Medicaid is broken is because of the laws of unintended consequences. Lower reimbursement leads to more procedures, often phantom relative to health improvement. Adult medicaid should be similar to what pedo Medicaid should be. Sealants, SDF in office and extractions and cases of only high complexity in the OR. Everything else is cosmetic and out of pocket non covered service or some copay that makes both FFS systems equal. There is no skin in the game for the patient, the new dentist is to debt ridden to see the truth and Medicaid is not a permanent healthcare solution for this nations poor. Without reforming to basics and rebuilding it is just an entitlement program to more than just the poor.
Jhirsch dmd mph

3/23/2017 2:58:25 PM
I have been treating dentical patients since 1979. The problem now is that the ACA put to many children on dentical. In our county alone we went from 27000 to 77000 children since 2013. The reason for this is that the income level for a family of four to qualify went from $32K to $72K/annually. We have the lowest fees in the nation and probably the highest costs of doing business in the continental US.  I have seen my income drop 80% from ten years ago. The ACA has put 90% of the children in our town on dentical and over half the children in CA. 
Why am I expected to give a 75% discount to a family making $72K year. Hopefully our fees will increase in 2018 or the income level to qualify will go back to 250% of the poverty level and not 400% like now