Government Relations
Join the fight for Pennsylvania ’ s Medical Assistance dentists and patients !
There is a growing awareness among lawmakers that dental Medical Assistance ( MA ) is woefully underfunded , and there is a particular concern about the lack of comprehensive services for adults .
A bipartisan group of legislators introduced HB 1417 , which requires the Commonwealth to reinstate services previously covered for adults before cuts were made in 2011 . In addition to a restoration of services , HB 1417 also eliminates the need for a Benefit Limit Exception ( BLE ) process to help provide dental services to adults that met certain criteria .
HB 1417 passed the House Health Committee in October . NOW is the time to notify your representative about the need for more funding to restore MA dental benefits for adults and to request support for HB 1417 .
It ’ s especially important for legislators to hear from those of you who are MA providers ! Please share your personal experience and any difficulties you have faced with caring for your patients .
Call , email , or schedule a visit with your representative before January 12 and request his or her support for HB 1417 , legislation that requires the Commonwealth to restore comprehensive dental coverage for adult Medicaid patients .
How to contact your representative : Enter your home address at https :// www . legis . state . pa . us / cfdocs / legis / home / findyourlegislator / to find their contact information . Or contact PDA ’ s government relations team at ( 800 ) 223-0016 or jpb @ padental . org , and we ’ ll provide you with the information you need .
What we ’ re asking for : That the House also pass HB 1417 to restore comprehensive services for adults in the MA program , and to appropriate enough funding in the budget ( with a 100 percent federal match ) to cover those services .
Thank you for being an advocate for your profession and patients !
Here are a few talking points to help guide your discussion :
• A 2020 study from the ADA ’ s Health Policy Institute found that reimbursement for children ’ s dental services is 58.5 percent of commercial insurance . Reimbursement for adult dental services is 56.1 percent of commercial insurance . Dentists ’ fees , which reflect the true cost of doing business , are already reduced by commercial insurers .
• Dentists are usually small business owners with significant overhead costs ( an average of 62 percent ), and they often do not “ break even ” when treating Medicaid patients . Accepting such low Medicaid rates is not financially feasible , resulting in many choosing not to enroll or dropping out of the system altogether . The Commonwealth must find a way to fairly reimburse dentists in individual or small group practices so that they can stay financially solvent and so that federally qualified health centers and other clinics do not become overburdened .
• All but one neighboring state has higher Medicaid reimbursement rates , ranging from 63.7 percent to 82.5 percent of commercial insurer rates . The same holds true when just comparing commercial insurer rates with neighboring states . Recent dental school graduates often leave Pennsylvania for more favorable practice environments , which ultimately impacts the number of dentists available to treat the Medicaid population .
• In 2011 , cuts were made to the adult Medicaid program so that it no longer includes coverage for periodontal and endodontic services , crowns and caps . It also limits dentures to one per lifetime . A restoration of adult services will : o Reduce out-of-pocket expenses for the poor . A study from CareQuest found that 93 percent of individuals living in poverty have unmet dental needs . Those who do seek care spend 10 times more of their annual family income compared to other families . o Improve job prospects for adults who suffer from missing or unsightly teeth . o Reduce costly emergency room visits . Pennsylvania is spending $ 35 million annually for non-traumatic dental care provided in ERs . o Save money in the health care system when periodontal services are provided to patients with chronic conditions like diabetes .
• Dentists are often forced into untenable positions when faced with the reality of having to pull teeth that they would rather restore , simply because Medicaid does not cover restorative services for adults .
• Less than one percent of Benefit Limit Exception ( BLE ) requests are approved , denying coverage to patients who need more comprehensive dental services before treatment for other health conditions like diabetes , cardiovascular disease , stroke , and Alzheimer ’ s disease . There is no need for the BLE process if Pennsylvania restored more comprehensive benefits for adults .
NOVEMBER / DECEMBER 2023 | PENNSYLVANIA DENTAL JOURNAL 9