Dentaquest And Virginia Health Catalyst Praise The State Benefit Expansion Commit To Increasing Awareness Among Medicaid Members And Providers
Low-income adults who receive Medicaid coverage can now obtain routine oral health care, thanks to a new law in Virginia that funds an oral health benefit for adults. Prior to today, the state Medicaid program only covered emergency oral health services–often tooth extractions. This expansion could impact 750,000 Virginians.
This is a real game-changer for a population that is too frequently left behind by our health care policies, said Steve Pollock, president and CEO of DentaQuest, the organization that administers the Medicaid dental benefit in Virginia and dozens of other states. Oral health care is health care, and weve long known the critical connection between the mouth and ones overall health. This state policy change is recognition of that importance.
Virginia Health Catalyst is a nonprofit public health organization that was instrumental in ensuring this benefit becomes a reality. This coverage will improve the health and well-being of hundreds of thousands of Virginians, said Sarah Bedard Holland, CEO of Virginia Health Catalyst. Being able to access oral health care isnt just going to improve physical health outcomes for many of our friends and neighbors. It will also assist with employability, improve mental health, and enable health systems to provide more equitable integrated care to Medicaid members.
Adults on Medicaid will now be able to visit the dentist for routine care three times each year.
About Virginia Health Catalyst
Virginia Aims To Expand Medicaid Dental Care Access By Increasing Provider Pay
RICHMOND, Va. -State lawmakers are taking steps to expand access to dental care for low-income Virginians.
Last summer, the states Medicaid program began offering dental care to nearly one million adult members. Following the massive expansion, Virginia is increasing pay for providers for the first time in more than a decade in hopes of expanding access to care.
Dr. Randy Adams, a pediatric dentist in Richmond, said it currently takes roughly a month to get an appointment but hes hoping to see that delay drop if more providers sign up to take on Medicaid patients.
It matters because dental care is a part of overall health, Adams said.
State data shows the number of dentists accepting Medicaid patients has fluctuated over the last ten years but, over the last five years, numbers have generally dropped. The total has decreased by 137 providers since the 2017 peak of 2,031, according to the Virginia Department of Medicaid Assistance Services.
After the state expanded adult dental benefits in 2021, former Governor Ralph Northam wrote a letter to 3,900 Virginia Dental Association members asking them to accept patients. DMAS says only five more providers started accepting Medicaid since then.
Adams said dentists were losing money on services because reimbursement rates were so low. As of July 1, Virginia increased how much dentists get paid by 30 percent.
Virginia Medical Fee Schedules
CPT copyright 2018 American Medical Association. All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
You May Like: Texas Medicaid Provider Enrollment Portal
Virginia Budget Increases Reimbursements For Medicaid Dental Care
CHARLOTTESVILLE, Va. – In the past few years the gap between private insurance and Medicaid has been growing in reimbursement for dentists. The new budget sets aside $116 million in state and federal funding to help fix it.
The governor is going to sign this on July 1 that will give us a 30% increase in Medicaid reimbursement rates, Charlottesville Pediatric Dentist Dr. Barrett W. R. Peters said.
Virginias new budget increases reimbursement rates by 30%. A change it hasnt seen in years.
For the past 17 years, there has not been an increase. The cost of doing dental business has increased about 60% in that period of time. So its very expensive to run a practice, Peters said.
He says this raises benefits patients and providers.
This reimbursement increase is humongous. It not only helps many patients across the commonwealth, but many children that need help, many adults that need help, Peters said.
It incentivizes more providers to accept any Virginian who has dental insurance under Medicaid.
Theyre going to find more providers, more people that are willing to participate in a program, because they feel like they can run their business effectively, and take care of the patients that so desperately need this, Peters said.
Peters encourages insurance companies to take a look at their own plans, so they can prevent toothaches before they even happen.
This reimbursement increase will go into effect when the new budget does on July 1, 2022.
Most Read
Virginia Budget Boosts Dental Medicaid Reimbursement Rates
More Videos
RICHMOND, Va.
The newly enacted Virginia budget will boost the reimbursement rate to providers of Medicaid dental services by 30%, a move advocates say will help expand the number of providers.
This year’s increase marks the first time since 2005 that reimbursement rates have been adjusted, the Virginian-Pilot reported Sunday. The budget directs $116 million in state and federal funding to cover the increase.
Ryan Dunn, CEO of the Virginia Dental Association, said the group has been pushing for the change for years. He said some procedures cost more for providers to perform than they are reimbursed from Medicaid.
Honestly, this 30% doesnt really get us caught up, but it does get us closer to where we need to be, he told the newspaper.
Virginia expanded its Medicaid program to provide a comprehensive dental benefit for adults in 2021.
You May Like: Can You Get Medicaid In Texas
Give Now Get The Match
Now through 12/31, all gifts are being matched dollar-for-dollar through NewsMatch. Every donation will be doubled.
As a nonprofit, we rely on you to power our journalism. We are committed to lifting up voices that arent always heard and showing solutions that are making a difference. But we cant do this without you.
Comprehensive Pregnancy Dental Benefits Improved Dental Coverage And Increased Dental Care Utilization Among Medicaid
- 1Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA, United States
- 2Oral Health Core, Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA, United States
- 3Department of Economics, School of Business, Virginia Commonwealth University, Richmond, VA, United States
Objectives: To evaluate the changes in dental insurance and utilization among pregnant women before and after the pregnancy Medicaid dental benefit policy implementation in 2015 in Virginia.
Methods: We used pooled cross-sectional data from six cycles of the Virginia Pregnancy Risk Assessment Monitoring System on women aged 21 years. Using logistic regression models and a difference-in-difference design, we compared the effects of policy implementation on dental insurance and utilization between pre-policy and post-policy period among women enrolled in Medicaid vs. those with private insurance . A p-value of 0.05 was considered significant.
The 2015 pregnancy Medicaid dental benefit increased dental insurance and dental care utilization among Medicaid-enrolled women and reduced associated disparities between Medicaid and privately insured groups.
Don’t Miss: How Do I Know If My Medicaid Is Still Active
Despite Reforms Medicaid Dental Care Still Leaves People With Expensive Problems
Until recently, West Virginias Medicaid offered no adult dental care except for emergency procedures like tooth extractions.
In March 2020, the Legislature revised the insurance program to add additional coverage. When the change took effect in January 2021, it gave recipients up to $1,000 of coverage for services like cleanings, root canals and dentures.
After that, Farlow started scheduling regular dentist appointments, checkups he hadnt been able to afford for about 15 years. But he quickly learned that his new dental insurance wont go very far. His dentist told him that, in the near future, he will need a full set of bottom dentures and four top teeth replaced he knows that type of procedure would far exceed $1,000.
I dont want to knock a gift, Farlow said. Its wonderful, great to have it. for the work I need, its not going to cover it in one year.
Jonathan Hill, a dentist who co-runs a private practice in Hurricane, said that Farlows experience is typical of many Medicaid recipients he treats.
In its current form, the states Medicaid program forces him and his patients to make difficult choices about which health problems they can and cant address.
I have multiple examples where a patient has 12 cavities but also hasnt had a cleaning in 10 years, he said. You just cant do everything you want to do, and that happens actually quite frequently.
Data Source And Study Population
This quasi-experimental study included the Virginia PRAMS data from 2013 to 2014 and 20162019 . The Virginia Department of Health, in collaboration with the Centers for Disease Control and Prevention , collects Virginia PRAMS data annually. Every year, mothers who gave live birth are randomly chosen from the Virginia birth certificate registry to participate in the PRAMS survey. The data is collected via mail/telephone survey and captures women’s experiences before, during, and just after pregnancy. Further details on the PRAMS methodology are available elsewhere . The Virginia PRAMS data from Phase 7 and Phase 8 surveys were obtained from the Virginia Department of Health. This study was reviewed and approved by the Institutional Review Board at the Virginia Commonwealth University and the Virginia Department of Health. Data from 2015 was excluded as the new dental benefit was only in effect for part of the year. Inclusion criteria included women age 21 and above and those with Medicaid or private health insurance during pregnancy. Women under 21 years of age were excluded because the Medicaid pregnancy dental benefit applied only to women aged 21 and above.
Also Check: Cpap Supplies Covered By Medicaid
Biden Promised To Focus On Environmental Justice So Far That Doesnt Include Finishing Key Review Of Mountaintop Removals Health Impacts
A 2018 research study determined that recipients who had vision care were more likely than those who didnt to hold full-time jobs and work longer hours.
Brandy Lipton, a UC Irvine public health associate professor and co-author of that study, said a reason that could explain the phenomenon is people with the additional coverage were more likely than their counterparts to drive to work.
We think that could be one thing behind the additional hours, Lipton said. You dont have to worry about catching public transportation at a certain time. You can just get in your car and go.
State Lawmakers Leaving Federal Money On The Table
If the West Virginias Legislature expanded dental and vision coverage, the state would only pay a fraction of the costs. A national fund called the Federal Medical Assistance Program would finance the majority of the expansion West Virginia would pay less than a fifth of the cost.
Enhanced coverage would also aid free clinics like Health Access. If the facilities were fully reimbursed for their dental and vision work, they would have more discretionary money to address other urgent health needs in their counties.
During the 2022 regular legislative session, Sen. Ron Stollings, D-Boone, co-sponsored a bill that would have increased the Medicaid dental insurance coverage to $1,500. A co-sponsor of the initial expansion legislation, he said the $1,000 cap was set to appease conservative lawmakers.
In his view, the first bill was necessary but insufficient.
Frankly, its not enough to really keep people from having oral health problems, Stollings said. Its a bite of the apple, a step in the right direction.
He sees both dental and vision care as crucial for developing West Virginias workforce.
Youre not going to be able to work if you cant see, Stollings said. If your teeth look terrible, youre not going to be able to pass an interview.
Im constantly on them Brush your teeth, brush your teeth, brush your teeth, he said. My mom was on me too, and I didnt take care of them the way I should have and needed to.
Recommended Reading: Medicaid Dentist Daytona Beach Fl
Glasses Out Of Reach For Many
Farlow first developed astigmatism about a decade ago. But because West Virginias program does not cover his corrective lenses, he has opted for pairs of generic, less expensive glasses from a drug store. They last about three months before becoming scratched and foggy to a point where he can no longer see through them. Now, he just goes without.
Its either looking through fog or looking through blur, Farlow said. And right now, its easier to see the blur.
West Virginias Medicaid adult vision program only covers eye exams that are part of larger wellness checks or considered medically necessary. It does not pay for glasses unless the recipient has had cataract surgery within the past 60 days.
Changing that would be up to state lawmakers, but nearly all of the cost would be picked up by the federal government.
When health care experts trace the repercussions from not providing Medicaid recipients with sufficient eyecare, they find that, like in Farlows case, the consequences can bleed into other parts of life.
Imagine trying to help your kids do homework, and you need a pair of glasses, said Kat Stoll, the West Virginians for Affordable Health Care policy director. But yet we want people on Medicaid to be good parents.
Free Clinics Offer Some Coverage But Only To Those Who Can Access Them
While some Medicaid patients seek out their annual $1,000 worth of care from private dentists like Hill, access to even that basic level of care is still an issue. Only about half of West Virginias 880-some dentists treated Medicaid patients last year, according to the states Board of Pharmacy and Bureau for Medical Services.
For those who cant get care from a dentist, or need work that exceeds their benefit, free clinics can fill gaps in certain areas of the state.
In Clarksburg, Health Access sits on a hill above the city center, just within eyeshot of old brick buildings downtown.
The idea in 1992 waswere going to take care of folks who are uninsured just for a short time until our government figures out what to do, said Josh Brown, Health Accesss executive director. Here we are 30 years later, and I dont think were any closer today than we were in 1992.
The West Virginia Department of Health and Human Resources supports nine comprehensive free clinics across the state, including Health Access. Inside its doors, uninsured and underinsured Harrison and Doddridge County residents receive free medical care ranging from chronic disease management to orthopedic medicine.
Every other Friday, that includes dental work. Roger Suter, a dentist who runs a nearby practice, treats patients for as much work as they need without the fear that theyll leave the clinic with a bill.
You May Like: How Do I Apply For Medicaid In Indiana
Why Some Virginia Dentists Will Be Paid More Starting Friday
RICHMOND, Va. Virginias new budget that goes into effect on Friday will include a boost in funding to Medicaid for dental care for the first time in 17 years.
The budget will include a 30% increase to dental Medicaid reimbursement rates, which means dentist will be paid more for treating Medicaid patients.
The Virginia Dental Association is calling the funding boost an important investment to support the oral health of Virginians.
VDA estimates the cost of providing dental care has jumped more than 60% since 2005, while Medicaid reimbursement rates have remained unchanged during the same time.
More than 924,000 Virginians have access to comprehensive dental services under Medicaid, which includes exams, X-rays and dentures.
Since July 1, 2021, VDA reports that approximately 158,000 of the adults eligible have received some form of treatment. The number of adults receiving restorative treatment has outnumbered the number of adults receiving just extractions.
Dr. Randy Adams owns and operates a pediatric dentist office on East Broad Street in Richmond.
Number one, its a big deal that theyre giving us the increase in pay. Its going to open it up for a lot for a lot more people. Hopefully, the increase in dental compensation will entice a lot more dentist to sign up and give patients a lot more choices, Adams explained.
The longtime Richmond doctor knows firsthand why dental care is so important. What happens in your mouth can impact your overall health.
Statement From Dentaquest President Steve Pollock On Signed 2023 Budget
Today, Steve Pollock, president of DentaQuest, the organization that administers the Medicaid dental benefit on behalf of the Commonwealth of Virginia, released the following statement reacting to Governor Youngkin signing the fiscal year 2023 budget:
The budget signed into law by Governor Youngkin is a big win for the health of Virginians. Increasing Medicaid reimbursement rates for oral health care will encourage more providers to participate in the program, which will increase the availability of care, allowing more people to see a dentist. Our elected leaders in Virginia have taken important steps over the last several years to increase access to oral health care, which we know is a critical part of ones overall health. With this increase, Virginia isnt just talking the talk on health care access and equity, but really is walking the walk. DentaQuest and the Department of Medical Assistance Services applaud the legislature, the Governor, and all of the organizations that helped deliver this win for Virginians.
Read Also: Dentist In Farmington Nm That Take Medicaid
