Wednesday, July 13, 2016

State oral-health leaders object to plan for Medicaid changes, say loss of dental benefit would cost state more than it would save

By Al Cross
Kentucky Health News

Oral-health leaders in Kentucky said Wednesday that Gov. Matt Bevin's proposed changes in the state Medicaid program would put some Kentuckians' health at risk, and that reducing dental benefits would cost money, not save it.

They also said the plan doesn't fulfill the intent and objectives of federal health reform and the waiver program that allows states to try demonstration projects within Medicaid.

Bevin says he will ask for a waiver that would allow the state to charge premiums and require able-bodied recipients who aren't the primary caregiver of a child to have a job, look for one, take job training or do volunteer work.

At the same time, Bevin is proposing to remove dental and vision benefits for all people covered by the 2014 expansion of Medicaid eligibility, and that is what has the oral-health community up in arms.

Medicaid members could earn dental and vision benefits through a rewards program, but the removal of the benefits "interrupts enrollment of a vulnerable Medicaid population, at the expense of quality health for the population and under the guise of controlling state expenditures," the dental leaders said in a press release.

They said the cost explanation for reducing dental and vision benefits was "fuzzy," and based on "flawed cost assumptions," noting that "adult dental expenditures comprise less than 2 percent of the cost drivers for the state share" of Medicaid.

They argued that removing the benefits would cost the state even more, because poor oral health increased "major cost drivers such as diabetes and cardiovascular disease," as well as obesity, and would increase wasteful use of emergency rooms. "All available scientific evidence indicates oral health should not be discretionary for any member of our population."

And they said removing the dental benefit "would be a major step backward for Kentucky," citing the thousands of people who gained access to oral health care through then-Gov. Steve Beshear's expansion of Medicaid under federal health reform. They said some rural dentists report that Medicaid is the only way some rural dentists are maintaining their practices. Loss of those practices would wind up hurting children, not just adults, they said.

The statement was issued by M. Raynor Mullins of the University of Kentucky Center for Oral Health Research; Jeff Ebersole, a UK professor of oral health science and director of the oral-health research center; Jim Cecil, a former state dental director and Medicaid dental director; Robert Henry of the Department for Veterans Affairs hospitals in Lexington; and David Nash, former dean of the UK College of Dentistry.

They predicted that federal officials would not approve the removal of dental benefits because the federal government has been placing more emphasis in integration of oral health and overall health care.

In more general comments, the five said the design of the plan is "inconsistent with the ample body of existing evidence on work requirements, reward programs and efforts to move Medicaid populations towards improved health and income status.  Second, the design as proposed is extremely complex. It would be cumbersome and expensive to administer and evaluate and we believe fundamentally creates an environment to discourage the ability of Medicaid population to access care."

The group did compliment the plan to expand treatment for behavioral health and substance abuse, "both of which are extensive unmet needs in the population of Kentucky."

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