CHARLESTON, W.Va. -- Fewer poor children in West Virginia will get dental care when the state changes the way it administers Medicaid later this year, a group representing dentists says.
The West Virginia Dental Association believes the new set-up will burden dentists, resulting in more tax dollars being spent on administrative costs, rather than on services for needy kids, said the group's director, Richard Stevens.
The state Department of Health and Human Resources plans to contract with managed-care companies to administer benefits of patients enrolled in Medicaid, the state/federal health insurance program for the poor. These companies also are called health maintenance organizations.
"It's the HMOs who benefit financially from this," Stevens said. "The HMOs are going to cover their administrative costs and they're going to cover their profit, before the money reaches the end of the line, where the care is provided."
He said the change would affect 160,000 children.
Stevens also cited a U.S. Government Accountability Office report released last week, which said federal officials have been inconsistent in their oversight of states' managed-care Medicaid contracts.
People covered by managed care must visit doctors and dentists who have signed up with a managed-care company's network. In the state's current fee-for-service system, someone can visit any provider who accepts Medicaid.
The approach can give states more predictable Medicaid costs because the provider network is paid a monthly fee for each enrollee.
Behavioral health providers and advocates for people with mental illness have raised similar concerns about other aspects of the shift. The state also plans to transfer the physical and mental health Medicaid benefits of 55,000 disabled West Virginians receiving Supplemental Security Income to managed-care companies.
Beginning Nov. 1, the dental and behavioral health benefits of children and families receiving cash assistance will be transferred to the managed-care companies, which already administer their physical health benefits. Dental coverage for adults on Medicaid is currently administered through managed care and is limited to a few services, such as cyst and tumor removal, and some emergency procedures.
The state will contract three managed-care organizations. Those companies will subcontract with two out-of-state third-party administrators for dental benefits, Stevens said.
That will cause bureaucratic headaches for dentists, he said. About 75 percent of West Virginia's dentists participate in Medicaid.
Stevens said most dentists want to help needy children, but many are wary of joining the companies' networks - and that will especially hurt children in rural areas.
For instance, in Monroe County, one dentist has already said he won't participate, Stevens said. There is only one other dentist office in the county.
"It's just incomprehensible to me that these issues have not been thought out," Stevens said, adding that the state also considered managed care last year but dropped the plan after dentists raised concerns.
Poor oral health is one of the Mountain State's most pressing health problems.
Earlier this year, the Pew Center on the States gave West Virginia an "F" for its investments in children's dental health. Still, a higher percentage of West Virginia kids enrolled in Medicaid -- about 46 percent -- receive dental care than the national rate of 38 percent.
Last year, West Virginia Medicaid increased reimbursement fees for 64 of 230 dental procedures.
"If dentists are saddled with administrative responsibilities that add to their costs," Stevens said, "the increased fees are negated."
Roughly 160 procedures are reimbursed at rates that are 30 percent below fees set in 1992, Stevens said.
State officials say the move is meant to integrate physical and behavioral health services because managed-care companies employ care coordinators.
Often, people receiving mental health services also have untreated physical health problems, and vice versa, said DHHR spokesman John Law.
"What we are trying to do here is gather the services around the client, as opposed to around the provider," Law said. "What we want is a care coordinator from the managed-care company to coordinate those services to see that they get them all."
Other health providers and advocates for people with mental illness have complained that the DHHR hasn't been transparent with its plans. Stevens echoed those concerns, saying the dental association didn't find out about the shift to managed care until June - and wasn't asked for input.
Federal officials recently approved the plan, said Law, who acknowledged that, in retrospect, the state should have held a public comment period on the changes.
On Monday, a legislative oversight committee is scheduled to hear from DHHR Secretary Patsy Hardy about the managed-care plan. The meeting is scheduled for 1 p.m. in the House Finance Committee room.
Reach Alison Knezevich at alis...@wvgazette.com or 304-348-1240.
