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Florida Dental Benefits One of the 5 Major Medicaid Changes Lawmakers are Considering in 2022

The restoration of dental benefits is one of the most important parts of the proposed Medicaid changes, currently progressing in the Florida House of Representatives. Republican Representative Sam Garrison introduced the bill to the House Health Care Appropriations Subcommittee in January 2022. It is now in the Health and Human Services Committee. Covering nearly 5 million Floridians, changes to House Bill 7047 will affect the Statewide Medicaid Managed Care (SMMC) program. If approved, dental benefits will be part of Medicaid’s managed assistance program. The next procurement will be conducted in 2022-2023 by the Agency for Health Care Administration (AHCA) in preparation for the 2024 expiration of current Medicaid managed contracts for dental and medical assistance programs.

Implications on Dental Benefits

States are not mandated to provide a minimum adult dental coverage. Hence, each state defines the amount and scope of services covered. Depending on their budgets, they may reduce or eliminate adult dental benefits. However, they are obliged to provide comprehensive dental services for children under 21 years as preventive measures and to promote oral health. In the period 2014-2018, dental benefits were part of the health plans which eventually increased the use of services in the state. 

Patients can visit a dentist in Orlando or anywhere in Florida in regular intervals to avail of dental care because it is part of the perks of the Medicaid plan. The services were included in the health insurance of beneficiaries under the program. Unfortunately, legislature directed the AHCA in 2016 to separate dental benefits as a stand-alone program. DentaQuest, Liberty, and MCNA Dental are the 3 dental plans available to Medicaid recipients

Oral Care as a Medicaid Managed Care Program

Audrey Brown, President of the Florida Association of Health Plans and Chief Executive Officer (CEO) said she believes that dental care is better provided through the Medicaid.  According to Brown, ‘Floridians are best served through a coordinated comprehensive care.’ Historically, the state has not performed well when it comes to Medicaid dental care. However, it was improving with annual dental visits up by 43% in 2013 compared to 34% in 2010 according to a Florida Politics article. Managed care plans for children also experienced growth.  

Performance continued to improve and in 2017, 51% of those enrolled in Medicaid went to see the dentist once a year based on Healthcare Effectiveness Data and Information Set (HEDIS) stats. Unfortunately, these gains did not continue when Florida executed the Medicaid dental contracts.  None of the 3 contracted dental plans reached their goals for preventive care delivery in the first 2 years of implementation. On the bright side, customers are quite happy with the schemes. Surveys indicate that the dental plans scored well for customer satisfaction and quality of care

The proposed revisions to HB 7047 will make changes to Florida’s Medicaid Program, one of which is the reinstallation of dental services under the SMMC. Hopefully, the move will improve the rate of dental service utilization in the Sunshine State.

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