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