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Regulation and Compliance > State Regulation

GAO Eyes Medicaid Dental Benefits

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Some states are improving Medicaid dental benefits by working with private insurers, or emulating private dental benefits programs, according to officials at the U.S. Government Accountability Office.

The GAO prepared a report on Medicaid dental benefits for children at the request of Rep. Dennis Kucinich, D-Ohio, chairman of the House Oversight and Government Reform Committee’s domestic policy subcommittee, and Rep. Elijah Cummings, D-Md.

The subcommittee began looking into the topic in 2007, after Deamonte Driver, a 12-year-old Maryland Medicaid plan member, died because he was unable to find a dentist who took Medicaid and was willing to help him overcome a tooth infection.

Since then, Congress and the Centers for Medicare and Medicaid Services have taken a number of actions to try to improve the dental benefits that Medicaid provides for children, but gaps remain, Alicia Puente Cackley, a GAO director, writes in a letter summarizing the GAO’s findings.

Only 37% of children ages 2 to 18 who are in Medicaid are getting any dental care, Puente-Cackley writes.

All of the 21 state that use managed care organizations to provide Medicaid dental services have set access standards, but 14 states say the dental managed care plans have failed to meet the access standards, officials report.

About 43% of the states say their residents have trouble finding dentists who take Medicaid, and 36% say low reimbursement rates keep many children in Medicaid from getting adequate dental care, officials report.

But many states have developed strategies to try to overcome Medicaid dental benefits shortcomings, officials say.

In Alabama, for example, the state has made a point of setting reimbursement rates at rates equal to those paid by commercial insurers, the GAO found.

Michigan contracted with one dental insurer, to ensure that all beneficiaries had access to the insurer’s dental network and would be treated as well as enrollees in employer-sponsored plans, officials say.

A copy of the GAO report is available here.


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