Denise Rangel: Prepaid dental is the answer


Published: Friday, December 6, 2013 at 1:42 p.m.
Last Modified: Friday, December 6, 2013 at 1:42 p.m.

I commend Gov. Rick Scott for running the state as he would a business, taking every chance to maximize and return taxpayer dollars. Gov. Scott's mission has been to make state programs most efficient by limiting waste and working to see dollars translate to jobs.

But one policy change being proposed by the Agency for Health Care Administration stands out as an exception to this rule and threatens to undermine the administration's credibility when it comes to taxpayer trust.

It isn't an issue that people think of every day, and it is not the most costly item in the budget, but it is an important one: children's dental care.

Medicaid managed care is expanding statewide, and the Agency for Health Care Administration is rightfully committed to seeing the program succeed.

One facet of this program entails Medicaid health plans to start providing for dental services, too. In making this move, the state will eliminate the current Prepaid Dental Health Plan (PDHP) that has been successfully operating since 2009 in Miami-Dade and since 2012 statewide.

The PDHP has taken Florida from the worst in the nation for children's dental care to making impressive strides in access and utilization. AHCA has correctly boasted these improvements.

So what will happen if children's dental care, and the $200 million currently directed toward it, is sent to Medicaid health plans?

Dental benefits are not something health plans normally handle in Medicaid or in the private market. Health plans don't have networks of dentists ready to go. They don't have experience with dental benefits. Consequently, one of two things will happen.

First, health plans may simply subcontract dental care out to prepaid dental health plans -- the same companies that are providing care under the PDHP today. In doing so, health plans will keep a middleman's fee, leaving fewer dollars on the table for dental plans to work with. Smaller pot, lower rates, fewer dentists providing care. The rest reads like Florida's track record on children's dental prior to the prepaid program.

Second, health plans may swallow the $200 million given by AHCA for dental care into their $20 billion big pot and quietly limit access to dental services. After all, in this scenario, health plans will have no financial incentive to increase dental utilization.

Why? In basic terms, health plans are required to use 85 percent of state dollars toward patient benefits. The same for prepaid dental plans. But while health plans have countless services and treatments that qualify toward this 85 percent threshold, prepaid dental plans have just one: dental care. This explains why the PDHP has done what other programs have been unable to accomplish.

AHCA claims that combining pots of money will lead to better coordination of care. This is far from true. Does AHCA really believe that health plans will use 85 percent of the $200 million they get "for" dental care toward dental care? With no actual requirement to do so?

Scott should take a lesson from a number of other states that had experimented with integrating dental care into larger health plans only to have to go back later and "carve" dental back out.

By contracting directly with dental managed care programs, Gov. Scott can ensure that each taxpayer dollar dedicated to children's dental is used for just that.

That's what makes the most sense in terms of accountability, transparency, and most importantly, children's health.

I write this as a dentist who provides care for low-income children, and equally, as a concerned taxpayer eager to see the governor continue making good on his vision for Florida.

Dr. Denise Vedrenne Rangel is a member of the Coalition For Independent Dentistry and a pediatric dentist in Marathon.

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