About 6 percent of eligible adults took advantage of new dental coverage offered under KanCare in the first year of the managed care Medicaid program.
The switch to managed care Medicaid administered by three private companies extended basic dental cleanings to more than 130,000 adults ages 19 to 64.
According to Kansas Department of Health and Environment statistics, about 7,600 adults had a cleaning paid for by one of the managed care companies in 2013.
Representatives of the managed care companies and dental providers offered several possible reasons why the cleanings rate, which dentists recommend twice a year, was not higher.
Ray Munoz, a coordinator at Douglas County Dental Clinic, said adults on KanCare might not know they now have insurance coverage for the cleanings.
“We do have to tell a lot of people that their coverage will cover certain things,” said Munoz, whose clinic serves low-income and uninsured residents of Douglas County. “It doesn’t seem like they’re aware of that before we tell them.”
The three managed care companies responsible for KanCare administration are Amerigroup, Sunflower State Health Plan (a division of Centene) and United HealthCare.
Denise Malecki, a spokeswoman for Amerigroup, also said she thought lack of awareness of the new coverage was a factor. The company has better rates of use for its children’s dental coverage, she said, but “adult dental services are a new KanCare benefit, so many adult recipients, who have never had access before, may not know how to use the services.”
As new benefits go, she said, the rate of adult dental use so far has been “better than expected,” citing the city of Iola as a region where use has been particularly high.
She said her company is working to make more adults aware of the dental benefits, in both written materials like member handbooks and one-on-one interactions.
“Our case managers and service coordinators conduct proactive outreach to encourage use,” Malecki said. “Also, our call center representatives are trained to provide information about available services and access when members call with questions.”
Need for higher-level care
Kendra Davis, who also works at the Douglas County Dental Clinic, said some KanCare clients who are aware of the new coverage can't take advantage of it.
Davis said customers who have been without regular checkups for extended periods of time often need higher-level dental care like periodontal maintenance, scaling or debridement - services that are not covered - before they can receive a basic cleaning.
Consequently, the clinic can’t order the covered services until a customer pays out of pocket to get caught up on years of higher-level dental care.
Malecki confirmed that some Amerigroup clients go to clinics for their cleaning only to “leave knowing that they need advance dental work and are unsure if they can afford it.”
“We want members to at least start with accessing basic screenings, so they know where they stand with their oral health and how it can impact their physical health,” Malecki said. “From there, we may be able to assist on a case-by-case basis so they can access advance services, especially when special circumstances exist or when there is medical necessity to avoid more serious health setbacks.”
Malecki provided three examples. In two cases Amerigroup helped clients find referrals so they could get their advanced dental work done at lower out-of-pocket costs. A third client received coverage for her fillings because she was undergoing chemotherapy that made it imperative that her teeth not be allowed to decay to the point of extraction.
“Extractions are a covered benefit, but fillings are not,” Malecki said via email. “However, in this situation, the chemo and radiation had made the member’s bones so brittle that extracting her teeth would cause her jawbone to crumble, resulting in the need for oral surgery and wires to hold her jaw together. Because of the medical necessity, we were able to help this member get special approvals to cover the cost of fillings, and the result was that more costly and painful oral surgery and services were avoided.”
Kevin Robertson, executive director of the Kansas Dental Association, said his organization would like to see Medicaid cover more services in KanCare. But he said the group’s members are pleased with the addition of basic adult dental coverage and encourage those who received it to take advantage.
Not doing so, he said, will end up costing more in the long run.
“If people take care of their teeth, brush regularly and seek preventative treatment from a dentist, dental services don’t have to cost that much,” Robertson said. “When things get out of control, now suddenly they’ve got cavities that linger and start having other problems.”
Robertson said he's aware of “some different pockets” of the state where it's difficult to recruit dentists and other areas where dentists did not join the managed care networks.
A September network report for the three managed care companies stated that 96.6 percent or more of KanCare clients in each of the companies had access to a dental provider. But the dental coverage map attached to the report shows many of the counties in western Kansas have only one provider who accepts Medicaid or none at all.
Amerigroup’s dental network is the most robust, with 425 providers at 305 locations. Sunflower State Health Plan is close behind with 413 providers at 300 locations, and United HealthCare has 391 providers at 287 locations.
Cleaning clinics
Miranda Steele, a spokeswoman for Sunflower State Health Plan, said her company is now using Centene's Dental Health and Wellness dental benefits manager, which she said will “help reduce the administrative burden for providers and provide the highest quality dental services for our members by being able to more closely coordinate all medical and dental care.”
“DHW began operations with Sunflower on August 1, and we’re looking at interventions such as hosting a series of dental cleaning clinics for adults and coordinating with medical outreach programs to improve access for our adult population,” Steele said.
Steele said Sunflower also had started offering sedation dentistry to adult clients with intellectual and developmental disabilities at some community health providers, like GraceMed in Wichita.
More covered cleanings could give a boost to low-income clinics like GraceMed, Marian Clinic in Topeka and the Douglas County Dental Clinic. Munoz said so far the clinic hasn't seen a difference with the added benefit.
“As far as the (KanCare) switch helping the bottom line, I would say it has a small amount,” he said. “Everything has been pretty much the same. It hasn’t really been very noticeable.”
