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Alabama Medicaid Agency

Alabama Medicaid Agency. Dental Program Statistics. Max Mayer, DMD Oral Health Coalition of Alabama September 23, 2010. Dental Program Changes from FY 2009 to FY 2010. Eligibles and Recipients Eligibles <21 remain the same - 531,296 Recipients receiving dental services up by 9,274

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Alabama Medicaid Agency

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  1. Alabama Medicaid Agency Dental Program Statistics Max Mayer, DMD Oral Health Coalition of Alabama September 23, 2010

  2. Dental Program Changesfrom FY 2009 to FY 2010 Eligibles and Recipients • Eligibles <21 remain the same - 531,296 • Recipients receiving dental services up by 9,274 • Recipients who had diagnostic services increased by 8,625.

  3. Dental Program Changesfrom FY 2009 to FY 2010 Utilization • Utilization rate increased from 44.04% to 45.79%, for an overall increase of 1.75% • Diagnostic procedures decreased by .06% • Preventive procedures increased by .26% • Treatment procedures decreased by 3.34%

  4. Dental Program Changesfrom FY 2009 to FY 2010 Provider Participation • Total number of enrolled providers increased by 68 to 764 • Number of performing providers increased by 579 to 654 • Significant providers (50 or more recipients) increased by 38 to 498 • Significant providers (100 or more recipients) increased by 29 for to 411 • Significant providers ($10,000 or more in paid claims) increased by 16 to 480

  5. CMS 416 Changes • Added line to collect dental diagnostic service data • Added line of data to collect eligibles receiving oral health services by a non-dentist • Added a second total column for eligibles who receive any dental or any oral health service • Lines added to count number of children who receive sealant on a permanent molar tooth. Will capture age group 6-9 and will also capture 10-14 age group for both dentists and non-dentists.

  6. Survey – Dental Home Concept • 77% agree that dental providers and Medicaid should pursue the dental home concept (10 of 13) • Concern: Assigning patients will not increase chance they will keep and complete appointments • Concern: Patients should not be limited to provider, e.g. patients should be able to go to any dental provider; prefer AAPD dental home concept.

  7. Survey – Age for Target Group • Dental providers are evenly divided on age group that should be initially targeted • 30 percent each for 1-2 years of age, 2-3 years of age and 4-6 years of age • One respondent (10%) preferred 0-1 year of age

  8. Survey – Initial Area • General consensus is that the Black Belt Region (primarily in West Alabama) would be the best area to target at first

  9. Survey – Improving Access • “Access isn’t the problem; parents are the problem” • Increase provider reimbursement • Seek grant and private funding to support expansion • Higher fees equal more access • Explore new funding opportunities to provide new access points • Programs to decrease no-show rates • Education and dental screenings in needy areas of state

  10. Survey – Improving Access • More facilities in areas of need; possibly with public health dentists (state/federal funding) • Dental care needs to be elevated to same priority as medical care • Require a dental “blue card” to begin school that includes a routine exam, not just screening • Require parents of pre-schoolers to identify a dental home for their child

  11. Survey – Improving Utilization • Care coordinators and/or community health workers • Education and understanding of need for good oral health – require for school programs (e.g. Blue Card) • Require recipients to show proof of visit to maintain eligibility • Educate parents as they apply for Medicaid

  12. Survey – Improving Utilization • Education and community outreach • Patient/family education • Benefit changes so parents are encouraged to make preventive visits • Food stamp benefits should only cover healthy foods • Educate parents as they apply for Medicaid

  13. Survey – Improving Utilization • Education and community outreach • Patient/family education • Benefit changes so parents are encouraged to make preventive visits • Food stamp benefits should only cover healthy foods • Educate parents as they apply for Medicaid

  14. Contact Information Program Information and Policies Nancy Headley – Director, Medical Services (334) 242-5684 nancy.headley@medicaid.alabama.gov Dr. Max Mayer – Medicaid Dental Consultant (334) 242-2312 max.mayer@medicaid.alabama.gov Agency website:www.medicaid.alabama.gov Dental Listserv:webformdata@medicaid.alabama.gov

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