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Medicaid update

States exchange stories, strategies on what works

When it comes to Medicaid, "Every state is different."

That's why the ADA held its second Medicaid Provider Symposium

Dr. Howard Elson of McKeesport, Pa., discusses how dentists can bring Medicaid patients into a dental practice as Dr. Sidney Whitman of Hamilton Square, N.J., listens
Ideas: Dr. Howard Elson of McKeesport, Pa., discusses how dentists can bring Medicaid patients into a dental practice as Dr. Sidney Whitman of Hamilton Square, N.J., listens.
July 12-13 at ADA Headquarters. Seventeen dentist participants—one from each trustee district—took a close look at a variety of practice models some U.S. dentists are successfully using today to bring Medicaid and State Children's Health Insurance Program patients into their practices.

"I think the most important thing the symposium did was to demonstrate and illustrate that, despite the difficulties—in some cases extreme difficulties—there are several strategies for successfully incorporating Medicaid patients into various practice models that are ethical, profitable and professionally rewarding," said Dr. Howard Elson of McKeesport, Pa., who represented the ADA’s 3rd trustee district at the symposium.

Building on the foundation laid with the 2008 Medicaid Provider Symposium, 17 private practice dentists who saw a significant number of Medicaid and State Children's Health Insurance Program patients in the last year were invited to participate in the 2010 symposium authorized by ADA House Resolution 42H-2009.

Before the July meeting, participants completed a survey through the Association's

Dr. Thomas Underwood of Nashville, Tenn., and Dr. Heather Heddens of Washington, Iowa
Dialogue: Dr. Thomas Underwood of Nashville, Tenn., and Dr. Heather Heddens of Washington, Iowa, share ideas during a break at the Medicaid Provider Symposium July 13.
Health Policy Resources Center that gathered information including the size and scope of their practices, how many hours they spend a week providing treatment, their income and expenses, the various kinds of patients they serve and what percentage of their patients are covered by Medicaid/SCHIP.

The electronic survey collected data to compare burden of disease, timely completion of treatment, staff proficiency in Medicaid program eligibility requirements, marketing of the practice, community outreach, referrals, scheduling and addressing missed appointments/late arrivals.

The data showed that 16 of the participants could be classified into one of three different Medicaid business models. One participant works through a mobile program that addresses the needs of Medicaid-eligible individuals within nursing homes and schools.

Dr. Matthew Coplin
Dr. Matthew Coplin
"The most important thing the meeting accomplished was bringing dentists together who successfully see Medicaid patients in a variety of practice settings," said Dr. Jeffrey Dow, the 1st District representative from Newport, Maine. "It was a great experience, learning from others, trying to put together common threads to help other dentists who want to be able to duplicate successful models and realizing that treating the underserved can be profitable as well as very rewarding."

"I was concerned about patient emergencies, but I found that a mobile dental program had a great plan for handling them," said Dr. Sidney Whitman, the 4th District representative from Trenton, N.J.

Dr. Jeffrey Dow
Dr. Jeffrey Dow
"Everybody learned something about the variety of ways to provide access to care for this population group."

Dr. Gregory Folse, the mobile program participant from Lafayette, La., in the ADA's 12th District, said the group "differentiated between lack of utilization of dental services—a parental education issue—and access to care for untreated Medicaid children. Because some children may never be placed in traditional dental home models in brick and mortar offices, the profession needs to support both traditional and nontraditional models to win the access to care battle."

The participants were a very diverse group, Dr. Whitman added, from large practices that spend a lot on marketing and advertising

Dr. Thomas Floyd
Dr. Thomas Floyd
to small practices that talk to people at churches and community centers to spread the word.

"Everyone in the group came away feeling they learned a lot and they took back to their constituents some new ideas," Dr. Whitman said. "Every state is different. Laws and systems are different, and it's imperative to understand how this works in your state and that you and your patients know how to navigate the system."

Dr. Matthew Coplin, the 11th District representative from Helena, Mont., was impressed by the "enormous amount of information and insight participants received. In that room of 17, I saw dentists who lived to do it, prospered from it and loved it. Some have made more than others financially, but the desire we all share to help is what we had in common."

Dr. Gregory Folse
Dr. Gregory Folse

Dr. Coplin also suggested that more information on treating Medicaid patients should be shared with dental students.

"Better and more in-depth exposure to the underserved side of dentistry would open the door to another avenue to explore in terms of what type of practice a student aspires to."

At the end of the meeting, participants offered two recommendations to the ADA Council on Access, Prevention and Interprofessional Relations. They encouraged CAPIR to form an advisory committee of dentists who treat Medicaid patients to advise the council and the ADA about issues related to serving this population group and to develop programs to inform students, residents and providers about how to address the oral health needs of Medicaid patients while maintaining fiscal viability within a dental practice.

Dr. James Mercer
Dr. James Mercer
"My hope is that the ADA will put programs in place that will make resources available to practitioners who are interested in implementing or learning from these strategies," said Dr. Elson, "whether it be a centralized resource center that can connect a practitioner who successfully treats Medicaid patients with a practitioner who wants to do so, or a presentation at ADA meetings or some resource materials that describe various models and dispel some of the myths many practitioners may remember from years past that may be precluding them from participating.

"This does not, however, in any way, take the place of the ADA and other interested parties from continuing to do everything they can to improve the actual dental programs, their access and delivery of quality dental services to our most vulnerable citizens. This is still a most important and difficult task."

For more information, contact Dr. Steve Geiermann by e-mailing geiermanns@ada.org or calling toll free, Ext. 2667.