Washington is one of the few remaining states not to have dental Medicaid benefits administered through a corporate managed care organization (MCO). But beginning January 1, 2019, the Washington State Health Care Authority will discontinue administration of dental Medicaid. The state has accepted bids from three outside companies for this work so far.
The three groups selected to date are MCNA Dental,1 Amerigroup (partnered with DentaQuest, a subsidiary of Delta Dental of Massachusetts),2,3 and Dentegra, which is a consortium between Delta Dental of Washington (DDWA),4 Delta Dental of California, and Arcora (a nonprofit foundation under DDWA).
The state will fund these three MCOs for dental Medicaid billing and payment processing, credentialing, and oversight of billings by providers. The administration costs are generally around 15% of total billings for services.
The Health and Human Services Office of Inspector General expressed concern in a recent report.5,6 In highly disturbing numbers, there exists precious little provider oversight by MCOs. Little information is shared with government authorities. Further, there is virtually no incentive for MCOs to withhold dubious Medicaid billings from payment.
When a substantial number of questionable payments are generated to a provider (often termed “credible allegations of fraud”), there exists little incentive for recovery by the MCO to do such, or to alert government authorities to hold payments. The problematic system of “pay-and-chase” is rooted in this dysfunctional program of MCO Medicaid administration.
Concerned Dentists of Washington State
Concerned Dentists of Washington State (CDWS) is a watchdog organization supporting a vibrant doctor/patient relationship, operational transparency within the insurance industry, and maximal dollars going toward patient benefits versus inflated salaries for insurance company executives. CDWS has been highly critical of Delta Dental.7,8 Both CDWS and the Washington State Dental Association (WSDA) have alleged serious ethical and legal violations by principals and officers of DDWA.9
DDWA has reached out to its current providers to sign on with its new Medicaid network. At the same time, CDWA reports that reimbursement rates for Medicaid dental services are only 25% to 35% of the current fee schedule of DDWA. Obviously, these fees to providers for dental Medicaid services are disturbingly problematic.
“You can’t take care of patients with a 75% fee reduction. This does not seem like an improvement,” CDWA advises in a statement on its website. “Who is benefiting?”7
Then, CDWA continues, “We already have our opinions about how Delta will ‘manage care’ in this system. With their market share growing and dominating the landscape, they will be able to continue to wield their influence. As they take over state supported agencies, they also become highly influential in state politics. Patient care will always take a back seat to corporate profits in the world of Delta. We have to continue to be vigilant in our quest to educate our legislators and the public that the best relationship is the doctor/patient relationship.”7
Delta Dental of Washington
DDWA provides “dental benefits for the public employees of the state. Its philanthropic arm, Arcora Foundation, is involved in numerous oral health improvement initiatives across the state, including the advancement of the nationally acclaimed Access to Baby and Child Dentistry Program (ABCD), which the Foundation helped bring to all of the state’s 39 counties over the past 17 years. Delta Dental of California [DDWA’s partner] delivers Medicaid managed oral health care in that state and several others,”4 DDWA said.
“One of the goals of the new managed care benefits programs delivered by the selected organizations is to expand access to care by increasing the number of dentists and other health care providers who will agree to provide oral health services to Medicaid patients. Other goals include reducing emergency room visits for dental services, improving oral health outcomes for Medicaid clients and coordinating dental care and medical care,”4 DDWA said.
DDWA did not respond to requests for clarification with specifics on how it expects to achieve these “goals,” especially regarding “increasing the number of providers” in light of Washington’s troubling Medicaid fee schedule.
Washington State Dental Association
“Delta, along with Amerigroup and MCNA, is one of three companies selected as the apparently successful bidders. WSDA will continue to diligently monitor the final negotiations and transition to managed care to ensure that all of the carriers are complying with the Health Care Authority’s rules and are not erecting any barriers that interfere with the doctor-patient relationship,” said WSDA president Cynthia Pauley, DDS. “This transition must be a success for both Washington’s providers and patients.”
Additionally, WSDA is currently asking membership to sign a petition demanding DDWA hold its annual membership meeting, which DDWA is not hosting this year.
“We have learned that, for the second year in a row, Delta is refusing to hold an annual membership meeting, despite that decision violating its own bylaws as well as state law,” the petition reads. “By refusing to hold an annual meeting for two consecutive years, the Delta Board of Directors is obstructing member dentist input into the selection of member dentist representatives on the Board. We can no longer stand by and let Delta erode our governance rights. Now is the time to demand that our voice be heard on the Delta Dental Board of Directors.”
- MCNA Dental. A Provider Friendly Program for Washington. Online provider enrollment 2018. http://www.mcnawa.net/
- Amerigroup/Washington. Apple Health. Your account 2018. https://www.myamerigroup.com/wa/benefits/apple-health-benefits.html
- DentaQuest/Washington. Improving Oral Health. Online login 2018. http://www.dentaquest.com/state-plans/regions/washington/
- Delta Dental of Washington. Delta Dental of Washington and Partners Selected to Provide Managed Dental Care for Washington Medicaid Recipients. Cision PR Newswire Aug 2, 2018. https://www.prnewswire.com/news-releases/delta-dental-of-washington-and-partners-selected-to-provide-managed-dental-care-for-washington-medicaid-recipients-300691593.html
- US Department of Health and Human Services Office of Inspector General. Weaknesses Exist in Managed Care Organizations’ Efforts to Identify and Address Fraud and Abuse. Report in Brief Jul 2018. https://oig.hhs.gov/oei/reports/oei-02-15-00260.pdf
- Davis MW. Office of Inspector General Calls MCOs’ Medicaid Reporting Weak. Dentistry Today Jul 30, 2018. http://www.dentistrytoday.com/news/todays-dental-news/item/3606-office-of-inspector-general-calls-mcos-medicaid-reporting-weak
- Concerned Dentists of Washington State. Delta Dental has Ventured into a New Business Model. Online home page 2018. http://www.concerneddentistsofwashingtonstate.org/
- Concerned Dentists of Washington State. Facebook page 2018. https://www.facebook.com/ConcernedDentists/
- Davis MW. Washington Dentists File No-Confidence Petition with Delta Dental. Dentistry Today Mar 23, 2018. http://www.dentistrytoday.com/news/todays-dental-news/item/3082-washington-dentists-file-no-confidence-petition-with-delta-dental
Dr. Davis practices general dentistry in Santa Fe, NM. He assists as an expert witness in dental fraud and malpractice legal cases. He currently chairs the Santa Fe District Dental Society Peer-Review Committee and serves as a state dental association member to its house of delegates. He extensively writes and lectures on related matters. He may be reached at firstname.lastname@example.org or smilesofsantafe.com.