Some state lawmakers want to ease financial restrictions that may cause many Medicaid patients to forgo dental care.
A bill advancing in the Vermont Senate, S.94, would nearly double Medicaid’s annual maximum coverage for dental procedures. And it says twice-annual visits for preventative care wouldn’t count against that coverage cap.
The bill also orders an examination of the state’s stagnant reimbursement rates, which have been blamed for a lack of Vermont dentists who are willing to accept adult Medicaid patients.
“I think it will send a very strong message that dental care is really important,” said Sen. Ginny Lyons, D-Chittenden and chair of the Senate Health and Welfare Committee, which approved S.94 unanimously earlier this month.
The legislation is a response to growing concern about the state of dental care and coverage in Vermont. While a 2018 survey said roughly 97 percent of Vermonters have health insurance, it also found that only 61 percent had any dental insurance and listed “cost of care” as the biggest reason why residents don’t visit a dentist.
A lack of adequate coverage by public insurers is a major issue. Medicare has no dental benefit at all, while Medicaid’s benefits are capped for adults at $510 annually.
Dentists have said that Medicaid cap discourages use of the benefit, and recent statistics seem to support that assertion: In a report submitted to legislators, the Department of Vermont Health Access said only 25 percent of adult Medicaid beneficiaries received dental care in fiscal year 2018, and just 9 percent received a preventative cleaning.
In contrast, there is no cap on Medicaid coverage for children and young people, and that shows in the usage rate: State officials report that 71 percent of Medicaid beneficiaries from age 2 to 20 received dental care in calendar year 2017.
Medicaid payments are another issue. In a 2017 survey, 96 percent of Vermont primary care dentists said they were accepting new patients, but only 60 percent said they would take new Medicaid patients.
The Vermont State Dental Society says Vermont’s Medicaid reimbursement rate for dental services is just under 50 percent, and those rates “have not been significantly raised in well over 10 years.”
As a result, “a lot of those dentists will only take a handful of adults, and not more than that – and they’re not accepting new adults,” said Vaughn Collins, the dental society’s executive director.
S.94 seeks to address some of those concerns, though it does not immediately propose a solution for all of them.
The version of the bill approved by Senate Health and Welfare allows adult Medicaid patients “up to two visits per calendar year for preventive services” with no copayment. Those visits “shall not be counted toward the annual maximum benefit amount,” the bill says.
The legislation also raises that maximum yearly benefit from $510 to $1,000, and it allows the Department of Vermont Health Access to approve additional money “when exceptional medical circumstances so require.”
Additionally, the bill sets up a working group consisting of the department, the Board of Dental Examiners and the dental society. One of the group’s tasks is to evaluate Medicaid dental reimbursement and “determine the amount of fiscally responsible increases … needed in order to attract additional providers to participate in the Vermont Medicaid program.”
The department’s fiscal 2021 budget proposal must include a report on the amount of money needed to reach the reimbursement rates recommended by the working group, the bill says.
The group also would discuss the possibility of a new state program that would “provide access to affordable dental services for Vermont residents who have lower income and are enrolled in Medicare.” That program could fill a clear gap: The state’s 2018 insurance survey found that only 31 percent of Vermonters age 65 and up have dental coverage.
However, it also would represent a substantial increase in the state’s coverage obligations. That’s “a big unknown from a fiscal point of view,” Lyons said, and that’s why the Health and Welfare Committee amended S.94 to study the concept rather than jumping right into the program.
“We will have to look at, how much will that cost the state,” Lyons said.
That’s also true for the bill’s loosened financial restrictions on Medicaid dental care. Officials are still developing cost estimates for those provisions, but some early guesses put the state’s obligations at over $1 million depending on future usage of the benefits.
Lyons said “everyone wants to move forward” with an expansion of Medicaid’s dental coverage. But it’s a question of “how can we do more without breaking the bank,” she said.
The Department of Vermont Health Access, which administers the state’s Medicaid program, is taking a similarly cautious approach.
The department “supports access to dental care in order to improve the oral health, and overall health, of Medicaid members,” said Nissa James, assistant director of the Blueprint for Health program.
James said officials “value the feedback” from providers who favor an increased annual limit on Medicaid dental benefits. But she added that “any changes to the dental benefit, as with any Medicaid benefit, will have a financial impact that must be considered.”
“Generally speaking, the options come down to cutting benefits, reducing reimbursements elsewhere or identifying new sources of funds,” James said.
Advocates argue that providing more Medicaid benefits for preventive care could save money by catching dental problems before they become more severe. Collins called it a “powerful approach” that could break a cycle of serious oral health issues among the Medicaid population.
The dental society also is continuing to push for higher reimbursement rates for dental care providers, saying they are a critical foundation for expanded benefits. Collins produced a chart showing that Vermont’s reimbursement ranks low among New England states.
“I’m convinced that the jump (in rates) will incentivize more providers to accept more patients,” Collins said.
Despite the uncertainties about funding, Collins said S.94 as it now stands is “mostly good news.”
“It’s a step in the right direction, for sure,” he said.
