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DentaQuest reinstates Medicaid dentists in Idaho

DentaQuest reinstates Medicaid dentists in Idaho
Dr. Dufurrena

Boise, Idaho—The private contractor that oversees Idaho’s Medicaid system reversed its decision Oct. 20 to drastically cut the number of dentists who provide Medicaid services.

The decision by DentaQuest, which holds a $39 million five-year contract, was thanks to persistent and strategic lobbying by the Idaho State Dental Association, with help from the American Dental Association. After losing millions of dollars during a previous contract, DentaQuest officials made changes to the company’s most recent contract but to the detriment of low-income, youth and disabled patients, said Dr. Quinn Dufurrena, executive director of the IDA.

Idaho Smiles provides dental coverage for Idaho Medicaid Basic Plan participants, covering about 140,000 residents. There is also a Medicaid Enhanced Plan that covers people with disabilities or special health needs. DentaQuest’s cuts affected both groups.

DentaQuest lowered the reimbursement rate for providers by 10 percentage points; reduced benefits; and through a statistical profile, cut the 150 dentists in the state who were providing the most Medicaid services per patient, Dr. Dufurrena said.

“We were concerned that tens of thousands of kids all of a sudden didn’t have the dentist they’d been going to,” Dr. Dufurrena said. “They’d basically be on the street looking for a new dentist, which would be difficult to find.”

The remaining dentists providing Medicaid would not be obligated to take on the influx of new patients, nor would they be able to handle them, Dr. Dufurrena said. Because of Idaho’s sprawling geography, access to care is already an issue and when you eliminate 150 dentists who provide services to the low-income population, it becomes even more of a problem, he said.

The new contracts for Medicaid providers went out Oct. 1 and were scheduled to go into effect Nov. 1. Dr. Dufurrena and IDA members rushed to contact legislators and the governor’s office to work out a new plan and worked with the ADA’s legal and state government affairs departments to develop a strategy for how to overturn the decision.

But it wasn’t until the issue was raised during the gubernatorial election race that the public and politicians started to pay attention.

On Oct. 20, Gov. C.L. “Butch” Otter convened a meeting between himself, Dr. Dufurrena, Steve Pollack, DentaQuest president, and Dick Armstrong, head of the Idaho Department of Health & Welfare, which oversees the DentaQuest contract, to come to an agreement. DentaQuest agreed it will not cut any providers and a dental advisory committee, consisting of five dentists and Dr. Dufurrena, will be formed to advise on the issue.

“We acknowledge that recent changes in the Idaho Smiles dental network were confusing. After careful consideration, we have decided to allow all dentists already enrolled in the Idaho Smiles program to continue their participation in the program,” according to a statement from DentaQuest. “We are redoubling our efforts to improve communications with the dentists, and we will create an advisory committee that we anticipate will include local dentists to provide input into the Idaho Smiles program. We appreciate the leadership from the governor’s office and look forward to working with all the parties under the terms of the new contract.”

The committee will also work on how to offset the loss in money DentaQuest experienced, prompting it to make cuts in the first place, Dr. Dufurrena said.

Currently 67 percent of the state’s dentists take Medicaid patients, well above the national average, he said.

The agreement between the governor, IDA, Department of Health & Welfare and DentaQuest was oral but it’s one Dr. Dufurrena believes will be upheld since it was made public through a press conference immediately following the meeting.

“We’re going to work together on this to make it worth it in Idaho,” Dr. Dufurrena said. “We’ve gone from an adversarial situation to a positive one.”