On April 18, the Connecticut Mirror ran “Critics: Proposed children’s dental cut threatens CT turnaround.” As a health economist who as extensively studied the connection between Connecticut’s reimbursement rates and access to care, I would like to provide some history on the issue as well as estimates that quantify how the governor’s proposed 10 percent rate cut could indeed threaten our state’s turnaround.
In 2000, Greater Hartford Legal Aid and Connecticut Legal Services brought a federal court class action challenge on behalf of Connecticut children enrolled in the Medicaid (HUSKY) dental program. The lawsuit contended that dental reimbursement levels were too low to enable dentists to participate.
Indeed, Medicaid dental fees for children and adults had not changed since 1993. During that 7-year period (1993-2000), the Bureau of Labor Statistics price index for dental services within the U.S. rose from 188.1 to 258.5, an overall increase of 37.4 percent, so it was clear that the reimbursement rates in Connecticut’s Medicaid dental program had become a serious barrier to dentist participation and the provision of essential services to Medicaid participants.
The suit was settled and in April 2008 Connecticut children’s Medicaid dental fees, with the exception of fees for orthodontic services, were increased to approximately match the 70th percentile of what the private sector fees had been in 2005. Since 2008, those enhanced fees have not been further adjusted for inflation and were expected to remain in effect until June 2016. As a result of the fee enhancement and a weak economy that encouraged dentists to serve Medicaid participants, Connecticut reached the envious position, by 2012, of being able to claim the elimination of access disparities across gender, race and ethnicity. This was a remarkable feat in a relatively short span of time.
Since the last adjustment (April 2008), private sector dental fees have continued to increase (at an annual rate of 3.39 percent in the last 10 years) and are expected to rise as much as 33 percent by 2018 (the end of the biennial budget). This increase in private sector dental fees is equivalent to a 33 percent reduction in the dental Medicaid reimbursement rates before the proposed 10 percent cut.
What is needed is an upward adjustment of the Medicaid rates — not a cut. The proposed dental fee cuts add insult to injury.
As Connecticut recovers more completely from the Great Recession in the next few years and the demand for dental services by private (non-Medicaid) patients expands, the proposed cut in dental fees for Medicaid patients would again create a barrier for access to dental care for the children of low-income families, and utilization in the state for that group would likely move back toward pre-settlement levels.
The lack of dental reimbursement adjustment combined with the proposed 10 percent cut in dental fees and the expected improved economic environment is likely to expand dentists’ non-Medicaid patient load and could seriously jeopardize the valuable gains in oral health that have been achieved.
A conservative estimate (one that assumes the state does not fully recover from the Great Recession) of the impact of reducing dental fees by 10 percent indicates that up to 30 percent of HUSKY A individuals with at least one dental visit could lose access to dental care.
If Connecticut’s economy recovers completely, as expected, the estimated number of HUSKY A individuals without a dental visit in the next two years could be much higher, since the more robust economy would allow many dentists to expand their services to the non-Medicaid population.
Tryfon Beazoglou Ph.D. is a Professor Emeritus at the University of Connecticut Health Center.