DENTAL CARVE OUT IN MISSOURI
Cutting the red tape & Increasing services
The MDA has long advocated for the estab- Fee For Service Kansas, have implemented a dental carve out.
lishment of a “Dental Carve Out” in Missouri. There are 61 counties that participate in a typi- Every state that has implemented a dental
Although we have lobbied for several years cal fee-for-service arrangement. In these coun- carve out has seen an increase in provider
on the issue, several misconceptions remain ties, the Department of Social Services directly participation and utilization. (In Kansas, for
about how the system would work and why it reimburses the dentist provider for procedures example, after establishing a dental carve out
is needed. performed on qualified patients. in 1998, the number of eligible children receiv-
ing an annual Medicaid dental visit went from
Opponents of dental carve out have used these MO HealthNet 24,855 to 54,362 by 2003.)
misconceptions to defeat the proposal. But we
believe this year could be different. Dental Providers In this arrangement, money for dental Medic-
Patient Services aid services is ‘carved out’ of the Medicaid bud-
With the many challenges facing the state get. This money is directly provided to a single
budget, it is more important than ever for Managed Care dental managed care company that develops
state programs to run efficiently. It is vital that In 53 counties and the City of St. Louis, Medic- a network of dentists to provide services to
money provided to the Medicaid system is used aid is provided through Managed Care. In these patients in all 114 counties in the state.
for patient services, rather than bureaucracy arrangements the state contracts with several
and red tape. Managed Care companies and pays a flat rate Dental Managed Care Company
to those companies based on the number of
We feel a state dental carve out would stream- Dental Providers
patients they cover. However, these companies
line the current operations of the MO Health- Patient Services
do not directly provide dental benefits. Instead,
Net program to create a better system for
they subcontract the dental services to a sec-
providers and—more importantly—for patients. This not only streamlines the current program
ond Managed Care company with a dental net-
work. These companies then develop a provider (by removing layers of bureaucracy) but also
WHY IS IT NEEDED creates a single set of rules that apply to all
network and reimburse dentists for procedures
The two most common complaints with the performed on their network patients. patients and providers (easier administration).
Medicaid system are: the reimbursements are
well below my usual fees (even below my over- LEGISLATIVE ACTION
head), and the system is too complicated. The MDA currently is asking the legislature
Managed Care Company
to establish a dental carve out during the
While we have had some success in improving Dental Subcontractor 2010 legislative session; however, it is our
fees, the complexity of the system remains a
Dental Providers understanding that some companies currently
problem—complexity that discourages dentists
Patient Services involved in the Managed Care system will op-
from signing up as Medicaid providers, leaving
pose our efforts.
some qualifying patients without a local Med-
icaid provider. A dental carve out will: As you can see, this layered system is compli- We are confident that our efforts to establish
• End the complicated system that currently cated even more by the fact that each dental a dental carve out will increase the number of
exists subcontractor can establish rules specific to children receiving preventive care, increase the
• Ensure that more tax dollars go to care their network. Therefore, a procedure that number of dentist providers and make the most
and less go to administration costs would be directly reimbursed by the state in a of tax payer dollars.
fee-for-service area may require pre-authori-
• Streamline the Medicaid billing operations The success of this item, as well as the rest of
zation with one dental subcontractor and may
in your office the MDA legislative agenda, will depend on the
only be offered to a specific population by an-
• Expand the number of dental providers in support of our members. We look forward to
other subcontractor. This arrangement creates
the state. your help.
confusion for the patient and the provider.
Ultimately, it improves the system and expands
CARVE OUT LEARN MORE
‘access to care’—a goal shared by many—with-
out adding to the state budget. With so many levels of bureaucracy, it’s no For question about dental carve out or other
wonder providers and patients find the system MDA legislative priorities, contact Aaron Wash-
confusing and complex and choose not to burn at email@example.com. Learn about MO
MO HEALTHNET TODAY
participate. HealthNet managed care regions at www.dss.
Currently the state’s Medicaid system is admin-
FOCUS | ISSUE 1 | 2010
istered in two different ways: Fee-For-Service
To streamline the system and make it more
or Managed Care.
efficient, 16 states, including Tennessee and