Overview of the Virginia Medicaid Program

1
Improving Access to Dental Care in Virginias
Medicaid/SCHIP Program
Presentation to National Association of State
Medicaid Directors 2008 Fall Conference
Patrick W. Finnerty, Director Virginia Department
of Medical Assistance Services
November 14, 2008
2
Virginia Medicaid/SCHIP Dental Benefits

• Dental benefits for children in Medicaid/SCHIP
  include
• Diagnostic, preventive, restorative/surgical
  procedures and orthodontics
• Dental benefits are not covered for Medicaid
  adults, except for limited oral surgery (e.g.,
  repair of traumatic wounds, extraction of teeth
  complicating a medical condition, etc.)
• Prior to July 1, 2005, a large majority of
  children received dental benefits through a
  managed care organization (MCO)

3
Access to/Utilization of Dental Services Needed
to Improve

• In FY 2003, only 23.4 of all
• eligible children actually
• received any dental services

4
Key Stakeholders Worked Together for Change
5
New Program Structure and a 30 Increase In Fees

• General Assembly/Governor authorized an entirely
  new program structure recommended by Virginia
  Medicaid
• Also approved a 30 increase in dental fees
• 28 on July 1, 2005 additional 2 in May, 2006
• An across the board increase of 23 the
  remaining amount was targeted to most critical
  codes (e.g., oral surgery codes)
• Dental advisory committee participated in process
  for allocating fee increase

6
A New Day for Dental! Smiles for Children

• Effective date July 1, 2005
• All children (Medicaid SCHIP) are enrolled in a
  single program administered by Doral Dental USA
• Limited medically necessary diagnostic/oral
  surgery services for adults
• DMAS retains policymaking authority and closely
  monitors contractor activities along with Dental
  Advisory Committee

7
Key Program Reforms
8
Value-Added Benefits for Providers

• Toll-free phone number for providers
• Call center specialists
• Member Placement
• Eligibility, benefits, authorizations
• Claims issues
• Addressing patient no-shows
• Multiple claim submission optionsfree,
  electronic filing
• Timely and accurate payments
• Automated, web-integrated or live eligibility
  verification (24/7)

9
Program Reforms Increased Provider Network

• 508 new dentists are participating (82 increase)
• Network continues to expand
• Several localities that had no participating
  dentists now have access
• Higher percentage of contracted providers are
  billing for services
• Very high level of provider satisfaction

10
..And Increased Access to Care
Percentage of Children Receiving Necessary Dental
Care
Source Centers for Medicare and Medicaid
Services EPSDT 416 Report produced on SFY
reporting timeframe. Figures are based on claims
received through September 30, 2008.