State Tackles Concerns in Medicaid Dental System

Despite the tone expected by dentists and managed care representatives, there were few fireworks at the dental stakeholders meeting held by the Health and Human Services Committee Friday. State officials and dental plan directors from the three Medicaid managed care organizations addressed previously submitted questions from dental providers, such as how they should treat orthodontic transfer patients, why some corporate clinics are allowed to use gift cards and pizza as incentives to lure new patients and other technicalities related to the transition to Medicaid managed care.

“I certainly understand what providers have gone through,” said Dr. John Roberts, the new Medicaid and CHIP dental director of the Health and Human Services Commission, who led the meeting.

As the Tribune previously reported, the allegations underpinning the panel’s calm answers are severe. One of the biggest complaints is the large number of children who got state-approved braces from Medicaid providers and who are now having a hard time finding orthodontists to treat them. As a result of the state’s crackdown on Medicaid fraud, many orthodontic providers who originally put braces on Medicaid patients closed up shop. The problem was compounded when dental plans assigned to patients through Medicaid managed care required the patients’ new orthodontists to recertify claims for orthodontic treatment, and many of those claims were denied.

“We all got together and tried to standardize how” transfers of orthodontic patients are handled, said Dr. Shaneequa Harris, the dental director for Delta Dental. And Dr. Carlos Garcia, the dental director for MCNA, said providers are encouraged to treat children who already have braces on their teeth.

Effective June 1, the managed care organizations no longer required orthodontists to recertify transfer patients who had already begun treatment through Medicaid, although the MCOs still reserve the right to review and deny orthodontic treatment for new claims.

The dental director for Dentiquest Texas, Dr. Monica Anderson, said they’ve received 1,840 new orthodontic treatment claims, and of those, only 160 were approved. She emphasized the dental plan’s approval rate for new patients to receive braces was around 9 percent.

Other concerns raised at the meeting involved how the MCOs selected the "dental home" for Medicaid patients. When the state transitioned to managed care in March, patients were required to select a dental home — a single provider who would ensure comprehensive, preventative dental treatment — or else the MCO selected one for them. Although managed care organizations were supposed to look at patients' dental records to assign them to their current providers, dentists complained many of their long-standing patients were assigned to large dental clinics.

A dentist from Sherman, Texas a submitted question alleging some Medicaid patients were being approached by corporate dental clinics with offers of free gift cards, pizza or dental cleanings for adults if they signed up whole families to become patients of record at that clinic. He asked how this was legal, given state and federal laws against solicitation of new patients.

Illegal solicitation of clients could result in penalties of up to $10,000 per offense, the Health and Human Services Office of Inspector General, addressing allegations the office had received, recently reminded dental providers. An attorney from the Texas State Board of Dental Examiners clarified that dental providers are allowed to give patients gifts, like $50 gift cards. Providers can’t orally solicit new patients or hire a recruiter to solicit patients for them, but they can advertise the gifts.

Dentists have also reported to HHSC that some families come in with multiple children who are assigned to different dental plans, which creates confusion for the parents and providers.

“We know with the high call volumes, patients had problems getting through” to choose their dental provider or switch dental plans, said Susan Gibson, director of managed care operations at HHSC, but that the state has improved the process so families can call HHSC and make those changes more easily.

She also reminded dental providers, “persuading or telling a client to pick or choose a particular dental plan over another,” is illegal and “you cannot tell them I do not like them, don’t’ choose them.”