Michigan’s Medicaid “ Healthy Kids Dental” Program: Assessment of the First Five Years
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Transcript of Michigan’s Medicaid “ Healthy Kids Dental” Program: Assessment of the First Five Years
Michigan’s Medicaid “Healthy Kids Dental”
Program: Assessment of the First
Five Years
Jed J. Jacobson, D.D.S., M.S., M.P.H.Senior Vice President, Professional Services and Chief Science Officer
• Nationally, children on Medicaid are far less likely than their privately-insured counterparts to:
– have access to and utilize dental services
– have a regular source of dental care or a “dental home”
– receive comprehensive follow-up if screened
– only 20 to 30% receive any dental care in a year
Why?Why?
• Reimbursement levels that are perceived as insufficient
• Administrative Burden– complicated and frequent
prior authorizations– delays in payment
• Excessive number of broken appointments
• Compliance
Healthy Kids DentalHealthy Kids Dental addresses addresses two, if not all of these dentist two, if not all of these dentist
barriersbarriers
• Collaboration with the MDA
• Pilot a “privately” administered panel program
• Based upon the MIChild model
In 2000, Michigan initiated the Healthy Kids Dental (HKD)
program offering dental coverage to Medicaid-enrolled children in
37 of its 83 counties
Healthy Kids Dental Program
• Administered by the Delta Dental Plan of Michigan
• Dentists paid usual Delta fees, same as for any other Delta-insured child
• Child may use any participating provider
• Program eligibility based on child’s county of residence
• Standard claims administration (same as for all other Delta patients)
• 100% payment (no patient co-payments)
• No annual maximum
Healthy Kids Dental Program – continued
37 HKD Counties
HKD enrollment by month, January 2001 through December 2005
12-Month Enrollment and Access
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
100,000
2001 2002 2003 2004 2005
EnrolledUsers
34.1%
49.0%
37.4%
50.4%
39.9%
51.4%
41.3% 42.2%
51.4%53.1%
Michigan Healthy Kids Dental utilization of dental care, 12 month enrollment in calendar year, by age
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
0 5 10 15 20 25
Age
Per
cent of en
rolle
d rec
eivi
ng d
enta
l car
e
HKD 2001
HKD 2005
Michigan Healthy Kids Dental utilization of dental care, 12 month enrollment in calendar
year, by age
Perc
en
t of
en
rolled
receiv
ing
den
tal care
Age
HKD, Medicaid, and Delta private utilization of dental care, 12 month enrollment in calendar year, by age
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
0 5 10 15 20 25
Age
Per
cent of en
rolle
d rec
eivi
ng d
enta
l car
e
HKD 2005
Delta 2005
Med 2004
Age
Perc
en
t of
en
rolled
receiv
ing
den
tal
care
HKD, Medicaid, and Delta private utilization of dental care, 12 month enrollment in calendar
year, by age
Participating Dentists
Number of dentists and number of children receiving treatment, by year.
Year Dentists Children treated(Children per
dentist)
2001 1544 48,714 (31.6)
2002 1624 57,032 (35.1)
2003 1715 63,856 (37.2)
2004 1773 68,058 (38.4)
2005 1926 74,027 (38.4)
Travel Distance
Year Total HKD providers
Average (and Median) Delta travel distance in miles
Average (and Median) HKD travel distance in miles
2001 1544 13.7 (7.6) 11.0 (7.5)
2002 1624 13.5 (7.9) 11.4 (7.6)
2003 1715 13.2 (7.9) 11.2 (7.6)
2004 1773 13.7 (8.1) 11.3 (7.6)
2005 1926 13.3 (8.0) 11.1 (7.6)
Travel Distance
Year Total HKD providers
Average (and Median) Delta travel distance in miles
Average (and Median) HKD travel distance in miles
2001 1544 13.7 (7.6) 11.0 (7.5)
2002 1624 13.5 (7.9) 11.4 (7.6)
2003 1715 13.2 (7.9) 11.2 (7.6)
2004 1773 13.7 (8.1) 11.3 (7.6)
2005 1926 13.3 (8.0) 11.1 (7.6)
Dental Home
Year Percent of Delta children with two or
more preventive visits per year
Percent of HKD 12-month enrolled
children with two or more visits per
year
2001 38.4 26.9
2002 38.0 29.7
2003 38.3 31.3
2004 38.7 32.0
2005 37.2 30.9
Procedures per User and Percent of Total
CostYear Diagnostic &
Preventive Restorations
2001 4.07 (41.7) 1.45 (38.5)
2002 4.17 (40.5) 1.47 (39.3)
2003 4.22 (41.4) 1.45 (38.8)
2004 4.31 (42.8) 1.42 (36.6)
2005 4.41 (42.2) 1.42 (36.1)
Summary• Access to dental care has
continued to improve as a result of HKD.
• More children and an increasing proportion of children received dental services each year.
• The number of dentists providing care continues to increase.
Summary - continued
• Children continue to access needed services from local providers close to home.
• Many HKD children appear to have a dental home and be entering regular recall patterns.
Implications
• Widely seen as an effective way to dramatically increase access to dental care for children.
• It has been adopted by the American Dental Association and the American Academy of Pediatric Dentistry as a model program for other states.
Healthy Kids Dental Expansion
Effective May 1, 2006, the Michigan Department of Community Health expanded the Healthy Kids Dental. Delta Dental will administer HKD in an additional 22 counties throughout the state!
This will increase the total number of counties to 59 of Michigan’s 83 counties.
To help finance this expansion, changes were also made to the payment structure in 2006.
Only 14.2% (12.35% of the General Dentists) opted out of the HKD in 2006.
59 HKD Counties