Proposed cut in dental reimbursement could jeopardize children’s care

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Gov. Dannel Malloy’s proposed budget charges the Connecticut Department of Social Services (DSS) with achieving $90 million in savings through a reduction in provider rates.

DSS is recommending Medicaid (HUSKY) provider rate reductions for 12 provider categories, including dental. The proposed 5.6 percent cut in dental fees may seem small, but on top of existing fee lags and the improved economic environment, it is likely to affect dental providers’ patient mix – reducing the access to oral health services by those covered by Medicaid.

DSS’ recommendation could seriously jeopardize the valuable gains in oral health that have been achieved.

To better understand the impact of this cut, the current proposal must be anchored by some history. In 2000, the Greater Hartford Legal Aid and Connecticut Legal Services filed a federal class action lawsuit on behalf of Connecticut children enrolled in HUSKY. The lawsuit contended that reimbursement levels were too low to enable dentists to participate, which severely limited access.

Indeed, Medicaid dental fees for children had not changed since 1993. During that seven-year period (1993-2000), the Bureau of Labor Statistics price index for dental services within the U.S. rose 37 percent, so it was clear that the static sub-market reimbursement rates in Connecticut’s HUSKY dental program had become a serious barrier to oral health providers’ participation and the provision of essential services to HUSKY members.

The suit was settled and in April 2008, children’s HUSKY dental fees, with the exception of fees for orthodontic services, were increased to match the 70th percentile of 2005 private sector fees. As a result of the fee enhancement, a weak economy that encouraged dental providers to serve HUSKY members, and provider outreach efforts, Connecticut reached an envious position.

By 2012, our state had eliminated dental access disparities for kids across gender, race and ethnicity within the HUSKY program and between publicly and commercially insured kids. This was a remarkable feat in a relatively short span of time.

Since the last rate adjustment in 2008, inflation in private sector dental fees has continued to increase; fees are expected to rise as much as 50 percent by 2017 (the end of the biennial budget). This increase in private sector dental fees is equivalent to a 50 percent reduction in the dental HUSKY reimbursement rates before the proposed 5.6 percent cut.

Based on standard economic modeling paradigms, a conservative estimate (one that assumes the state does not fully recover from the Great Recession) of the impact of reducing dental fees by 5.6 percent indicates that 24,000 fewer HUSKY-insured young people under 21 years of age would have access to a dental visit in each of the next two fiscal years.

If Connecticut’s economy recovers completely, as expected, the estimated number of HUSKY individuals without a dental visit in each of the next two years could be as high as 81,000 since the more robust economy would allow many dentists to expand their services to non-Medicaid patients.

Tryfon J. Beazoglou, Ph.D. is professor emeritus in the Department of Craniofacial Sciences, School of Dental Medicine University of Connecticut.  Dr. Beazoglou is a seasoned researcher with an extensive record of publications and rich experience in funded clinical research, economic evaluations, and modeling.

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