Fortunately, the Florida Legislature recognized this as a serious crisis and included dental services as an expanded benefit under Florida’s Statewide Medicaid Managed Care program. The Florida Association of Health Plans Inc. fully supports this expanded benefit since we already know “carved-in” dental coverage works.
Take into account that in Florida’s Medicaid reform counties where dental care is carved in, health plans have increased access to dental care. In 2011, the annual dental visit rate for one plan’s members who resided in a reform county was 14 percent higher than counties where dental care was carved out. Further, in 2012, more than 32 percent of those health plan members residing in a reform county who were between the ages of 2 and 21 had an annual dental visit — nearly a 5 percent increase from 2011.
Additionally, the state has already taken significant steps toward securing this expanded benefit under the managed-care program when the Agency for Health Care Administration recently negotiated adult dental services with select managed-care plans. Under this expansion, nine health plans will have the ability to offer dental coverage to more than 800,000 Floridians. These expanded benefits are offered by the health plans at no cost to the state, meaning the cost of providing the coverage comes from the health plan’s administrative expenses and/or profits, not at the expense of taxpayers or any other Medicaid recipients.
Unfortunately, there has already been misinformation perpetuated by a segment of the dental managed-care industry that would benefit from a “carve-out” from the statewide managed-care program and who would like to maintain the status quo. Should the special interests who support a carve-out be successful, not only would those 800,000 Floridians lose out on the opportunity for dental coverage, but it would result in the loss of expanded dental benefits valued at more than $100 million over the next five years. Additionally, the carve-out could endanger the already negotiated managed-care contracts, potentially requiring the state to start the process anew.
Further, it’s important to note the medical loss ratio in Florida is set at 85 percent to ensure companies are spending more on health care and services rather than focusing on profits. However, the special interest that is a key proponent of the carve-out has a dismal loss ration of 50 percent in Miami-Dade County. This means that entity is spending only half of every dollar it receives from the state to provide dental care on actual services; obviously, this special interest is neither efficient nor focused on delivering quality health care services.
Overall, better health outcomes result from keeping the responsibility for all health care under a single managed-care entity, allowing a focus on the whole person rather than fragmenting care. Floridians are served better through a single, coordinated system which emphasizes the link between good oral health and good overall health. Furthermore, to reverse what is already being implemented under the Statewide Medicaid Managed Care program in favor of maintaining the status quo will result in Florida reverting to the fragmented system of care which has failed to provide these critical services.
All in all, dental carve-out is a bad deal for Florida and the Florida Association of Health Plans encourages lawmakers to defeat it.