Pennsylvania Medical Assistance : Evaluation of Children ’ s Access to Dental Services
least one Medical Assistance patient in 2009 . That proportion is low . This is concerning because 55 Pennsylvania areas are experiencing a shortage of dental professionals and the number of licensed dentists has decreased . 41 Pennsylvania has also undertaken a number of important initiatives to streamline and improve the Medical Assistance program . We believe that these changes should have a positive effect on children ’ s dental health , but future data and formal evaluations of the initiatives will reflect Pennsylvania ’ s grade . It will probably be difficult to increase the proportion of Pennsylvania dentists without a major increase in fees , which is currently unlikely . In the meantime , Pennsylvania may be able to increase children ’ s access to dental services by considering policies to improve the delivery of dental services in the Medical Assistance program , similar to the North Carolina and Washington models .
Monica Costlow , JD is a Senior Policy Analyst with the Pennsylvania Medicaid Policy Center at the University of Pittsburgh . Ms . Costlow earned her JD from the University of Pittsburgh School of Law , in addition to an Advanced Certificate in Health Law . She previously worked as a compliance consultant for a multi-specialty physician practice .
Dr . Judith Lave is a Professor of Health Economics , Director of the Health Administration Program , Director of the Pennsylvania Medicaid Policy Center and co-director of the Center for Research on Health Care at the University of Pittsburgh . Prior to coming to the University of Pittsburgh , she was the Director of the Office of Research at the Health Care Financing Administration , now CMS . She received her PhD in economics from Harvard University . She is the author of more than 140 scientific publications .
FOOTNOTES 1 The Pew Center on the States , The Cost of Delay : State Dental Policies Fail
One in Five Children , February 2010 .
2 The focus of the article is on children ’ s dental services , but we would like to acknowledge that Pennsylvania Medical Assistance covers a comprehensive dental package for most enrolled adults and limited emergency dental services .
3 Disability Evaluation Under Social Security , September 2008 . http :// www . ssa . gov / disability / professionals / bluebook / general-info . htm
4 If a disabled child is in a family that has a private insurance policy , than the private health insurance policy is the primary payer . Medical Assistance covers those services that are not covered by the private health insurance policy .
5 Pennsylvania Department of Public Welfare Medical Assistance Enrollment
Data , Author calculation 6 Id . 7 US Department of Health and Human Services : Centers for Medicare & Medicaid Services , Region III ( Pennsylvania EPSDT Review Report- Dental Services . April 2008 Site visit ) Final Report . December 31 , 2008 . 8 Id . 9 Medical Assistance Handbook , http :// www . dpw . state . pa . us / oimpolicymanuals / manuals / bop / ma / Table % 20of % 20Contents . htm 10 Department of Public Welfare Data , Author calculations 11 Id .
12 Hiroko et al estimated that in 2005 average dental expenditures per child were $ 252 , which is about $ 284 in current dollars . ( Hiroko I . et al . “ Dental care needs , use and expenditures among U . S . children with and without special health care needs .” J Am Dent Assoc 2010 ; 141 ; 79-88 .) More current data on expenditures per child are not available .
13 The Pew Center on the States , The Cost of Delay : State Dental Policies Fail One in Five Children , February 2010 . This is the FFS Medical Assistance reimbursement rate . Managed care payment rates are proprietary .
14 Department of Public Welfare Data . These data relate to children who are continuously enrolled ( i . e . they may have no more than one enrollment gap of 45 days ) over the measurement year , which goes from January 1 to December 31 . 15 Id . 16 The dates in the graphs are for the reporting year and actually refer to use in the prior year . In addition , Medical Assistance MCOs determine utilization rates using either 10 or 12 month continuous enrollees . CMS uses the total number of children enrolled in Medical Assistance , which they determined to be 27 percent in their 2006 report .
17 Note that data for Gateway for 2008 and 2009 are not available because of administrative errors by a dental contractor . Information provided to authors by Gateway Health Plan .
18 Pennsylvania Department of Health , “ 2009 Pulse of Pennsylvania ’ s Dentist and Dental Hygienist Workforce .” Volume 4 , October 2009 . 19 Pennsylvania Department of State Data 20 Pennsylvania Department of Health , “ 2009 Pulse of Pennsylvania ’ s Dentist and Dental Hygienist Workforce .” Volume 4 , October 2009 .
21 Medical Assistance MCOs are able to negotiate fees and reimburse Medical Assistance non-participating dentists for services rendered on an out-of-network basis . 22 Department of Public Welfare Data 23 Id . 24 Information provided to authors . These dentists may identify the Medical
Assistance managed care plans as being private insurance . 25 Pennsylvania Department of Health , “ 2009 Pulse of Pennsylvania ’ s Dentist and Dental Hygienist Workforce .” Volume 4 , October 2009 .
26 United States General Accounting Office , “ Oral Health : Factors Contributing to Low Use of Dental Services by Low-Income Populations ,” GAO / HEHS-00-149 , September 2000 . 27 Id . 28 Pennsylvania Department of Health , “ 2009 Pulse of Pennsylvania ’ s Dentist and Dental Hygienist Workforce .” Volume 4 , October 2009 .
29 US Department of Health and Human Services : Centers for Medicare & Medicaid Services , Region III ( Pennsylvania EPSDT Review Report- Dental Services . April 2008 Site visit ) Final Report . December 31 , 2008 . 30 Id . 31 Id . 32 Previously HB602 , now Act 19 33 Pennsylvania Department of Public Welfare , Medical Assistance Bulletin http :// www . dpw . state . pa . us / PubsFormsReports / NewslettersBulletins / 0036731 69 . aspx ? BulletinId = 4526
34 R . Gary Rozier , et al . Prevention of Early Childhood Caries in North Carolina Medical Practices : Implications for Research and Practice . Journal of Dental Education , Volume 67 , Number 8 .
35 Shelly Gehshan and M . Wyatt , “ Improving Oral Health Care for Young
Children .” National Academy for State Health Policy , April 2007 . 36 Id . 37 The Pew Center on the States , “ Washington ’ s ABCD Program : Improving
Dental Care for Medicaid-Insured Children ” June 2010 .
38 Washington Dental Service Foundation , “ Access to Baby and Child Dentistry Program ,” http :// www . deltadentalwa . com / Guest / Public / AboutUs / WDS % 20Foundation / Strategic % 20Focus % 20and % 20Programs / Access % 20to % 20Baby % 20and % 20Child % 20Dentisty . aspx
39 The Pew Center on the States , The Cost of Delay : State Dental Policies Fail One in Five Children , February 2010 .
40 The Kaiser Commission on Medicaid and the Uninsured , “ Dental Coverage and Care for Low-Income Children : the role of Medicaid and SCHIP .” January , 2008 .
41 Pennsylvania Department of Public Welfare , Dental Information for Stakeholders and Advocates , http :// www . dpw . state . pa . us
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