07/08/2008
Medicaid adult dental benefits and fees restored, effective July 1

Sarah Surface
Managing Editor

After cuts, restoration announcements, delays and more restoration announcements, adult dental Medicaid benefits and reimbursement rates have been restored effective July 1.

The restoration, backed by Gov. Ted Strickland, restores adult dental Medicaid services and provides rate increases for many healthcare providers, including dentists.

Prior to Gov. Strickland taking office in 2007, former Gov. Bob Taft implemented significant changes to the dental Medicaid program, including eliminating coverage for certain services and cutting reimbursement fees.

The effects of these changes were felt by many Ohio dentists, as practice expenses had gone up, but Medicaid reimbursement fees had gone down. The changes also meant low-income Ohio citizens no longer had Medicaid coverage for certain critical dental services.

In March 2007, Strickland recommended the Medicaid budget include a restoration of coverage for dental services and dental fees and an increase in reimbursements for community providers, including dentists, physicians and clinics. The General Assembly passed the state budget, including funding to restore the dental Medicaid program, effective Jan. 1, 2008.

However, in November 2007, the Strickland administration announced plans to delay the restoration of Medicaid benefits, citing budget concerns and escalating Medicaid caseloads.

As reported in the January 2008 issue of ODA Today, many Ohio dentists experienced budget concerns because of the reduced reimbursement fees.

ODA member Dr. Tom Neiderhelman, who has seven offices throughout Ohio that regularly see Medicaid patients, was faced with the difficult decision of potentially laying off staff members and has reduced office hours approximately 40 percent since the original Medicaid reductions in 2006.

In January, Strickland again announced plans to restore Medicaid benefits, this time effective July 1, 2008.

"I hope to reopen those hours after the reinstatement," Neiderhelman said. "However, I will receive the same fees I received in January 2000. The reinstatement will help, but the problem of rate reimbursement is still an issue."

Strickland's Medicaid budget, effective this month, will restore fees and benefit levels to those effective from January 2000 to December 2005. This includes restoring a two percent across-the-board cut in reimbursement fees and an additional five percent cut in denture services, along with the restoration of services cut during the Taft administration.

Medicaid rules are also changing relative to multiple restorations performed on multiple surfaces of the same tooth.

"Medicaid HMOs will have to mirror the Medicaid fee-for-service program in this regard," said Chris Moore, ODA director of dental services. "They will no longer be permitted to bundle these restorations into a large, single restoration."

Medicaid HMOs will still be permitted to set their own fee levels and prior authorization requirements; however, the capitation rate the state pays the HMOs will be adjusted to reflect the higher fee-for-service fees and benefit levels.

Overall, the ODA is encouraged by Strickland's reinstatement of Medicaid benefits.

"The decision to restore Medicaid services and increase fees is something the ODA has advocated since cuts were enacted during the Taft Administration," said David J. Owsiany, ODA executive director. "We are glad to see Gov. Strickland has not changed his perspective on the value of the dental Medicaid program."

Synopsis of restored adult dental Medicaid benefits
The following is an overview of changes to Ohio Medicaid adult dental benefits as provided by the Ohio Department of Job and Family Services (ODJFS), based on the initial filing of the program rules.

These changes/restorations went into effect July 1, 2008. According to ODJFS, the funds allocated in the new budget, plus the dollars saved by no longer separately reimbursing for additional clasps for partial dentures, allow for a full restoration of the fee and service reductions that occurred in 2006.

Former program:

• One annual routine exam and cleaning
• X-rays
• Fillings
• Simple extractions
• Root canals for anterior teeth
• Dentures services including full and partial dentures
• Anesthesia (general and local)

New program:

• One additional routine exam and cleaning
• Anterior crowns, posts and related services
• Posterior root canals
• Complex tooth extractions

Additional dental program and rule revisions:

• Revised dental PA forms
• Revised definition for separate multiple surface restorations on the same tooth
• Eliminated separate reimbursement for additional clasps for partial dentures
• Restored all fee reductions made in 2006