GDAction February 2009 USING
3/9/09
11:18 AM
Medicaid: Death by a Thousand Cuts “The state of Medicaid and PeachCare dental care in Georgia is in a severe crisis. . .The GDA will continue the pursuit of a carve out [from the current Medicaid managed care model], but it is highly unlikely in the current economic situation and with the current administration.” The infrastructure of Medicaid has been dying a slow death for years. Occasionally there will be an attempt to revive the dying program with an infusion of dollars or a promise to eliminate administrative problems that make providing care difficult if not impossible. One such rescue was made in 1999 when the state proposed a 33% increase on 64 codes and 10% increase on the remainder of the codes for the FY99 budget. While this was a significant increase, it only raised the reimbursement closer to 50 cents on the dollar, and was not enough to entice dentists, who were already disenchanted with the administrative hassles, back into the program.
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In 2002 a proposed 5% increase in dental fees was deferred to save the public health dental program that was threatened with elimination. In 2003, the dismal lack of access to dental care forced the state to provide a 3.5% cost of living increase for dental fees, despite a monumental state budget shortfall. In 2004, the dental budget took a 7.5% budget cut but this time dentistry named its own poison and proposed the elimination of 11 codes to maintain fees for the other codes that would starve the program but not quite kill it. In 2005, dentistry was faced with the total elimination of the small amount of adult dental services provided under Medicaid as well as the complete elimination of dental care in PeachCare for Kids, the state’s SCHIP program. With the help of a coalition of advocates, the GDA succeeded in saving the adult program and dental coverage in the PeachCare program. In 2006, the elimination of the limited adult dental program and dental coverage under PeachCare were again threatened. Governor Sonny Perdue ultimately added adult dental coverage in his budget but cut dental coverage in PeachCare by $1.74 million with the elimination of additional dental codes. On June 1, 2006, an infamous day, the state of Georgia moved all of their plans, except coverage for the aged, blind, and disabled, into an “at risk” managed care program. Three Care Management Organizations (CMOs) and two dental administrators took charge of the dental program. The movement into managed care speeded up the death by a thousand cuts of dental care in the Medicaid and PeachCare program. From January 1 to August 31, 2007, the three CMOs sent out 14 letters outlining changes to their dental plans that involved cuts in fees and limitations on services and frequency of treatment. The CMO panels were closed and 123 dentists were dropped from the plans. Additional fee cuts followed from January 1, 2008, to the present. Georgia’s dental program in Medicaid and PeachCare has been cut and slashed to the point that it is barely alive. The state Department of Community Health responded to a national survey in October 2008 and reported that only 499 Georgia dentists have filed dental Medicaid claims for more than $10,000. If
the threshold had been $100,000, it is likely that number would have dropped into the 200s. The state of Medicaid and PeachCare dental care in Georgia is in a severe crisis. Although the Centers for Medicare and Medicaid Services (the federal agency that manages these programs) and other agencies have audited the state’s dental Medicaid and PeachCare programs, no data has been made available. The State Senate ordered an audit of the program last year and the results were revealed in December 2008. The state’s own auditors substantiated many of the claims of an inadequate provider network and lack of quality data that have been asserted by the GDA. An analysis of this audit will be presented to the Senate leadership with a request for further study. An all-out GDA attempt to “carve out” dentistry from the state’s Medicaid managed care plan came to a screeching halt in 2008. The GDA worked with the American Dental Association and two well-respected Atlanta public relations firms in a coordinated effort to use the media and various other mechanisms to accomplish a carve out for dentistry. The efforts were effective to a point. Most legislators were on board with the carve out and would have voted on legislation that would accomplish this goal. However, we were unable to get the carve out over the final hurdle that would have allowed the bill to be signed. The GDA will continue the pursuit of a carve out, but it is highly unlikely in the current economic situation and with the current administration.
GDA ACTION FEBRUARY 2009
GDAction Feb 2009 FINAL.pdf 21
2/10/2009 9:44:05 AM
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