“Oral health for all”

March 2017

Talking Points for Advocates on:

GOVERNOR’S BUDGET PROPOSAL TO LIMIT ELIGIBILITY FOR HUSKY A

DO NOT REDUCE HUSKY A ELIGIBILITY

Eligibility for HUSKY A was reduced in 2015 from 201% to 155% of the federal poverty level (FPL). The Governor’s budget for 2018 – 2019 proposes to reduce that further to 138% of the FPL. Dental Medicaid is an excellent investment, not only because oral health is critical to overall health and well-being, but the lack of dental care can result in debilitating pain and loss of teeth, which can lead to poor nutrition, the ability to get and retain employment, and lower self-esteem.

The consequences of reducing eligibility to 138% of FPL:

  • Would cut off about 9,500 low-income parents from health benefits.
  • During the last shift from 201% to 155%, only 16% (3,100 out of 18,900 people) were able to get and keep insurance through the Access Health Connecticut exchange because, even with subsidies, they could not afford the premiums.[1]
  • Would result in NO dental benefits for these 9,500 citizens.
  • Since dental insurance is expensive, they are more likely to forgo dental visits, and may need to rely on more costly emergency departments visits for dental pain.
  • HUSKY Adults who lose coverage are expected to move to Access Health CT medical plans with annual costs they cannot afford AND NO dental benefit included in that cost.
  • Would decrease the number of children receiving necessary dental care.
  • When parents don’t get dental care, their children are less likely to as well.[2]
  • Loss of dental Medicaid is detrimental to health, nutrition, employability and self–esteem.
  • Poor oral health and lack of regular access to dental care are related to serious and expensive systemic health conditions and diseases. The elimination of dental services for adults in the 138-155% FPL range will significantly drive up healthcare costs.
  • Emergency Departments will experience dramatic increasesin visits due to dental problems.
  • It costs 3 – 10 times more for an emergency room visit for dental pain and often the cause is not treated.
  • Patients often leave with pain medication, including opioids.

March 2017

Talking Points for Advocates on:

GOVERNOR’S BUDGET PROPOSALTO IMPOSE A CAP ON MEDICAID ADULT DENTAL

DO NOT IMPOSE A CAP ON MEDICAID ADULT DENTAL SERVICES

The consequences of a $1000 cap on adult dental Medicaid:

  • Cuts about 16,200 low-income adults from comprehensive dental care, including parents, persons with disabilities, and seniors, according to the CT Office of Fiscal Analysis.[3]
  • Most adults on HUSKY are working andearning low wageswhich prohibit them from paying for services above the $1,000 cap.
  • As written in HB 7040, dental practices would be required to send in prior authorization (PA) to prove medical necessity for every service, including preventive, diagnostic, restorative and simple extractions. It may preclude persons from receiving more advanced but medically necessary care, emergency care, and dentures.
  • The large increase in the number of PAs would be a major administrative burden and increase the cost to the Department of Social Services.
  • The requirement for PAs for all services would increase administrative burdens for dental practices, reversing one of the outcomes of the settlement of the Carr v. Wilson-Coker lawsuit in 2005, which reduced administrative burden.
  • Increases the use of emergency departments by HUSKY adults for dental pain.
  • Research shows that when states reduce or eliminate adult dental benefits, preventive dental service use decreases, unmet dental care needs increase, and the costly use of emergency departments for dental problems increases.[4] Emergency Department visits can cost 3 – 10 times more than dental visits and often do not lead to treatment of the issue.
  • When dental services are not available in the hospital, antibiotics may be prescribed whether needed or not.[5] In addition, addictive opioids may be prescribed for pain.[6]
  • Leads to higher costs to the state.
  • Unfinished cases can get progressively worse, leading to infection, inflammation, and possible loss of teeth which in turn would require more expensive dental and medical care.

If you must allow the cap on Dental Medicaid, COHI recommends the following amendment to HB 7040, Sec. 24. Subsection of section 17b-282c of the general statutes: (COHI new language in green bold)

“Payment for nonemergency dental services shall not exceed one thousand five hundreddollars per fiscal year for an individual adult, [subject to]provided that any dental services in excess of this amount shall beapproved by theDepartment where medical necessity is met in accordance withthe provisions of section 17b-259b,provided further that emergency dental servicesand denture-related servicesshall not becalculated inthisannual limit and that emergency dental services shall not besubject to prior authorization.

  • According to a Report bythe Office of Fiscal Analysis for Human Services, the cap would not apply to denture-related costs1, but that is not apparent in HB 7040, Sec, 24.[7]
  • According to the Governor’s Budget, Section B, “this proposal institutes an annual benefit limit of $1,000 on adult dental services and provides for exceptions based on medical necessity.” This is not reflected in HB 7040, Sec. 24.[8]
  • Emergency dental services should never require PA nor be denied as certain infections can lead to death when that infection gets to the heart, lung, brain and other parts of the body.
  • This new language would decrease the number of prior authorizations that the Department of Social Services would need to review, decrease the administrative burden for dental practices, allow patients to receive necessary treatment for their overall health, and maintain current level of access to care.

Talking Points for Advocates on:

HUSKY DENTAL SUCCESSES

  • HUSKY Dental currently operates very efficiently, in a fiscally conservative manner, providing only appropriate services. More patients with comprehensive dental care are getting preventive care annually, which results in the state paying less for dental and related medical services.
  • Changes in Medicaid have resulted in great strides in reducing disparities in oral health.[9]
  • Actual Expenses for Husky Dental in 2009-2010 were $230M, and $188M in 2014-2015.That is a total savings of $42 million dollars per year as we moved from treatment of oral disease to prevention.[10]
  • The Actual Expenses mentioned above decreased while utilization increased, rising from 46% to approximately 62% (the highest utilization in the nation according to the American Dental Association) with more people enrolled in the Medicaid program due to Medicaid expansion and enrollment efforts.
  • Unlike in many other states, CT adults on Medicaid have access to comprehensive dental coverage, including preventive, diagnostic, restorative care and surgical care.
  • Adults in low-income families are better able to access dental care[11]as a result of the 2005 Carr v. Wilson-Coker lawsuit settlement.
  • CT has increased the number of Dental Medicaid providers, from 300 in 2007 to over 1,500 today. This is considered an adequate number to provide care for Medicaid-eligible residents.

Since the 2008 rate adjustment, private dental fees have continued to increase, while the value of Medicaid fees paid to dentists continues to decline—by an estimated 50% at the end of the 2017 budget. Despite this, more than 1500 of the 2600+ dentists practicing in CT treat Medicaid patients.The Centers for Medicare and Medicaid Services (CMS) issued guidance in 2012 for state Medicaid programs, reminding them that “dental coverage through Medicaid is a powerful tool that states can use to improve oral health.”[12] The following strategies were recommended by CMS and have already been implemented in Connecticut:

Improving state Medicaid program performance through policy changes;

Maximizing provider participation in Medicaid;

Directly addressing children and families; and

Partnering with oral health stakeholders.[13]

The increase in utilization of dental services by adults, decrease in decay experience, and decrease in Care Cost Trends can be attributed directly to the increase in reimbursement rates and a lower administrative burden for dentists.

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[10]Contact CT Dental Health Partnership for references.

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