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Milwaukee Dental Insurance Individual

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					Improving Medicaid patients’
access to dental care




July 2007
Vast majority of dental diseases are infectious,
irreversible and destructive.




   40-year-old male (patient has dental insurance) seen by Dr. Mick
    McCormick (Mauston).
July 2007
Dental diseases can only be diagnosed and
successfully treated with proper intervention by
a licensed dentist and qualified dental staff.

   In Wisconsin, state and federal governments spend
    less than one percent, or just $38 million of $4.4
    billion annual Medicaid (MA) budget, on oral health
    programs for children and adults.

   Four out of five states spend higher percentage of
    MA dollars on dental care for children and adults than
    Wisconsin, according to the American Dental
    Association (ADA).


July 2007
    The American Academy of Pediatrics (physicians) says
    20 percent of all health care funds spent on children
    should be directed at improving and maintaining oral
    health.




     Four-year-old female; Green Bay resident treated at First
      Impressions in Wausau due to lack of MA providers in her
      community. Disease so advanced pediatric dentist had to treat at
      Wausau Surgery Center under general anesthesia.


    July 2007
    First Impressions has been committed to seeing
    children on MA despite the financial losses this
    imposes on the practice.




                 Four-year-old female from Green Bay.
     First Impressions is a multi-practitioner pediatric dental
      practice that gets only 40 percent return on MA
      billings. (Break-even point for most dental offices, not
      including dentist’s salary, is about 65 cents on the
      dollar.)
    July 2007
Maintaining one’s oral health improves overall
health and can help keep health care costs
lower.




    23-year-old female MA patient treated by Dr. McCormick early in
                                  2007.
   Paying reasonable rates improves a person’s access to
    a “dental home” where he/she can receive
    comprehensive dental care.
July 2007
Death of 12-year-old, low-income boy in Maryland from
a severe brain infection that spread from an abscessed
tooth illustrates that neglecting dental health can be
serious and costly.



   It was reported a dental extraction costing $80
    accessed early on would have solved the 12-year-
    old’s problem; follow-up medical treatment, which
    unfortunately did not save the child’s life, cost
    $250,000. Stories such as this are heartbreaking
    and unacceptable in a society such as ours.




July 2007
95 percent of Wisconsin’s practicing dentists are
small business owners.




    23-year-old female MA patient treated by Dr. McCormick early in
                                  2007.

    Small-business owner dentists do not impose a
     “hidden tax” on private-pay patients by cost-shifting
     losses incurred through participation in an
     inadequately-funded state dental MA program.
July 2007
Dr. McCormick billed the state’s MA program for one
comprehensive oral exam, PAN X-rays, a three-surface
resin filling and surgical removal of two teeth for a total
cost of $919.




   He received a state MA reimbursement check for
    $283.65 or just 30.8 percent of the real cost.
July 2007
MA patients experience insufficient
access, because…


   …of the state’s lack of commitment to
    this program dentists either limit their
    MA participation or drop their
    certification.




July 2007
 Dental access improves when fair-market rates
 are implemented.
                  Dental Medicaid Rate Increases at a Glance
                                                               Percent Increase in
             Payment to Dentist After   Percent Increase in           Dentists
  State               Increase                Utilization           Participating

Tennessee      ADA 75th percentile            43.30%                111.66%

 Indiana       ADA 75th percentile           122.22%                 90.01%

 South          Private sector 75th
                                              47.51%                 93.38%
  Carolina            percentile
                  Based on Delta
Michigan          Dental's "Preferred        144.44%                300.00%
                   Option" network

Delaware     85% of submitted charges        484.30%                 57.33%

              ADA 25th percentile or
 Virginia                                     20.83%                 25.95%
                       below
 July 2007
One out of every two WDA practicing dentists
recently answered a questionnaire about dental
MA participation.

   Nearly 80 percent of respondents said they would
    begin seeing or see new MA patients if rates were
    raised to the 75th percentile of the most recent
    ADA fee survey for this region of the country.
   The 50 percent of WDA member dentists who
    responded to the questionnaire alone would see
    approximately 111,400 new MA patients.
   140,000 patients currently receive dental services
    annually under the fee-for-service MA program in
    Wisconsin.

July 2007
The WDA asks the Legislature to prioritize dental
funding within the state budget and increase dental MA
reimbursements to the 75th percentile.




 Four-year-old male MA patient treated by Dr. McCormick in 2007.

   Increasing rates would cost the state an additional
    $20 - $30 million in General Purpose Revenue (GPR)
    per year.
   If approved, the state would still spend less than two
    percent of its entire MA budget on dental services.
July 2007
    Legislators must decide if the state’s poorest
    citizens deserve to have two percent of the MA
    budget dedicated to improving their oral health.




    Teenage male patient of Dr. Michael Donohoo (Milwaukee) with dental problems
                      caused by excessive soft drink consumption.
   If legislators are unwilling to prioritize funding for dental access
    within the state budget, the WDA proposes fair reimbursement
    rates be provided by implementing a fee on distributors,
    manufacturers and wholesale dealers of soda.
   An estimated two cents per 12-ounce can of soda – Two Cents for
    Tooth Sense™ – could generate approximately $70 million in
    additional revenue each year.
    July 2007
    Charity is NOT an oral health care system.




    Volunteer data collection shows an individual WDA
     dentist appears to donate $10,000 - $12,000 worth of
     care each year in addition to the free services he or
     she may provide through MA, Donated Dental
     Services, Give Kids A Smile or other charitable
     programs.
    July 2007
True oral health prevention requires a
comprehensive approach.

   Professional diagnosis by a dentist
   Regular dental examinations with X-rays
   Necessary restorative and periodontal treatment early
    in the development of dental disease
   Regular personal oral hygiene practices
   Observance of a healthy lifestyle and dietary habits
   Consumption or application of appropriate fluoride
    supplements
   Appropriate placement of dental sealants
   Patient education

July 2007
Access to oral health care is a promise
Wisconsin has made to its Medicaid children and
adults.



       It is time for the state to
        prioritize funding so the
        promise of dental care to
      Medicaid patients can become
                  reality.

July 2007

				
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