It’s no secret that children in Medicaid lack adequate access to oral health care for a number of reasons. These include low provider participation due to perceived administrative burdens, relatively low reimbursement amounts, and high no-show rates. Children who are unable to access oral health care are more likely to suffer from progressive dental disease, which can lead to low self-esteem, missed school days, costly ER visits, and, in rare and tragically preventable cases, even death.
Fortunately, state Medicaid agencies — particularly those with managed care delivery systems — are well-positioned to implement strategies that encourage better oral health care access and outcomes for children. Below are five key strategies Medicaid agencies can implement with their managed care partners to improve oral health care for children.
- Offer financial incentives for plan performance. Financial incentives reward a contracted plan for meeting specific benchmarks in children’s oral health care access (e.g., percentage of enrolled children who had an annual dental visit). States can structure the incentives in a number of ways, including requiring that plans meet a specific minimum standard on a measure, improve their performance over the previous year, and/or beat the all-plan average for a given measure. For example, New York awards bonuses to its dental plans that exceed the statewide plan average on select HEDIS and CAHPS measures.
- Establish non‐financial incentives for plan performance. Non-financial incentives – such as assigning new Medicaid beneficiaries to higher-performing plans – are another option for states seeking to improve oral health care access. Michigan adjusts new member plan assignments every quarter using an algorithm based on plan performance.
- Impose consequences on plans for failure to meet performance standards. States can also impose penalties – financial or non-financial – on plans that fail to meet minimum performance standards. For example, Arizona’s Medicaid program requires plans to develop a corrective action plan and pay up to $100,000 per missed measure when they do not meet certain performance standards.
- Reduce obstacles to oral health care provider participation in the Medicaid network. There are a number of strategies states can employ to encourage provider participation in Medicaid and CHIP. For instance, states can require plans to align their administrative processes (e.g., use uniform reporting forms); remove or agree upon prior authorization requirements; and/or use centralized credentialing that certifies a provider to participate in all Medicaid plans. Virginia, for example, has implemented a number of these strategies to reduce barriers for provider participation.
- Engage health plans to promote oral health. Medicaid-contracted health plans can also play an important role in ensuring that children receive oral health education, screening, and referrals by their primary care provider. A recent study by the University of Florida found that a Medicaid policy reimbursing pediatricians and other primary care providers in Florida and Texas for basic oral health screenings and cavity prevention increased the likelihood of children receiving these services by up to 25 percent. At least 44 states — including Alabama and Texas — have similar policies.
Considerations for Implementation
States implementing the above strategies should keep in mind the following considerations:
- Engage contracted plans early and often;
- Give network providers a voice at the table;
- Consider a phased-in approach;
- Create mechanisms for providers to report access-advancing services; and
- Determine how to evaluate the effectiveness of these strategies.
CHCS has been working with seven states — Arizona, California, Minnesota, New Hampshire, Texas, Virginia, and Washington — over the past two years through its Medicaid Oral Health Learning Collaborative to address children’s oral health care access. As these and other states work toward improving oral health access and outcomes for low-income children, Medicaid contracting strategies may prove to be a valuable tool in their efforts.