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Dental care, 'undwind' topics for Medicaid tour
McCOOK, Neb. — There’s no “magic bullet” when it comes to making dental services more easily available to Medicaid patients, but officials hope a series of small changes will make a difference.
Many dentists are reluctant to take on Medicaid patients because their practices can’t afford the low reimbursement rates and $750 annual dental benefit maximum for patients who often need extensive care.
As a result, Medicaid patients are forced to travel across the state for care, or forego dental care altogether.
There’s also a “misalignment” of incentives to provide preventive care which could avoid more expensive dental bills in the future, Kevin Bagley, director of Nebraska’s Medicaid program told a small group gathered at McCook Community College on Monday.
With him on a “listening tour” stop were the CEOs of the three companies that are or will be administering Medicaid in Nebraska: Jeff Stafford of the UnitedHealthcare community plan, Heath Phillips of Nebraska Total Care, and Frank Clepper of Molina Healthcare, which will be taking over for Healthy Blue Nebraska, which lost the bid to continue providing services.
The “misalignment,” Bagley said, is that while MCNA is paid to provide services for each patient, there is no incentive for it to pay for preventative care. As a result, problems are put off until they become severe enough to result in an emergency room visit, which is then covered by the patient’s medical coverage, not MCNA’s dental coverage.
Beginning Jan. 1, 2024, the three medical plans will begin managing dental coverage to Medicaid patients, which should provide the added incentive to prevent more serious dental problems.
At the same time, the $750 annual cap will be removed, and Public Health Hygienists will be able to provide dental care for Medicaid patients, hopefully increasing the number of providers and easing “the struggle to access dental care.”
Other dental changes include updates to reimbursement for dentures, asymptomatic wisdom tooth extraction and streamlined credentialing for providers.
But funding originates with the taxpayer, and it’s up to Nebraska Legislators to provide funding to pay dentists for their work.
A legislative bill now under consideration calls for a 25% increase in the reimbursement rate, which would be on top of a 3% increase last year and 10% two years ago, but “rates are not a silver bullet,” Bagley said, pointing to experiences in other states. “Rates are just a part of the problem,” and it is hoped all of the changes combined will help.
Drawing more attention lately is the “unwind,” to reestablish eligibility for Medicaid patients who would have otherwise lost coverage during the national emergency declared during the pandemic.
Since no one was “disenrolled” after October 2020, the Medicaid roll has grown from some 250,000 individuals to 400,000, including many who should no longer be eligible because of changing personal circumstances.
About half of the increase is due to expanded services, but the rest need to be moved out of the program, a process that will take a year, Bagley said.
But while Medicaid has an open enrollment period, Nov. 1 to Dec. 15, where patients can choose among the three providers, those who become eligible can receive coverage at any time.
Other information outlined during the listening tour:
• Postpartum coverage will be extended from 60 days to 12 months, improving coverage for nearly 5,000 mothers.
• Coverage for newly eligible children will expand from 6 months to 12 months.
• Medicaid clients are urged to make sure contact information is updated so eligibility is not ended unnecessarily.
• Children may still be eligible even if their parents are no longer eligible. Children up to age 19 might lose coverage if their information is not updated.
• While Medicaid members can change health plans Nov. 1 to Dec. 15, they are not required to do so. Those who are with Healthy Blue, and who do not choose another plan, will be assigned to Molina Healthcare before Jan. 1, 2024.
A new one-stop shop for Nebraskans opened just Oct. 16, iServe.nebraska.gov, where benefits such as food, utilities, healthcare, childcare and other important needs can be accessed. Users, however, may be directed back to ACCESSNebraska during the transition.
Other ways to update eligibility or obtain more information include
email DHHS.ANDICenter@nebraska.gov,
fax (402) 742-2351
TDD: (402) 471-7256.
DHHS.ne.gov