Iowa dental Medicaid benefits changing on July 1

Starting July 1, Medicaid enrollees on the state's dental plans will notice some changes to their benefits.

Iowa is one of 15 states to offer its Medicaid beneficiaries a dental option. Nearly 300,000 have enrolled either through the Dental Wellness Plan - the Medicaid expansion - or traditional Medicaid, according to Department of Human Services data.

Typically, there is a good deal of churn between these two populations - meaning they fluctuate back and forth between the plans, depending on income and other eligibility requirements, said Julie Lovelady, deputy director of Iowa Medicaid Enterprises.

This may not seem like a big issue, but it can produce confusion for enrollees and administrative headaches for providers when the dental benefits differ.

'The member would go to a dentist and start a treatment plan that goes over the course of a few months, and they'd come in the next month and be on a different plan - this caused quite a bit of confusion,” said Jeff Russell, president and chief executive officer of Delta Dental of Iowa.

More than 800 Delta Dental dentists see Medicaid patients, Russell said, with more than 95 percent of dentists seeing multiple patients a month.

MCNA Dental, the second insurer, has about 240 participating dentists.

The state hopes that by offering the same set of benefits to both sets of Medicaid populations, it can streamline administrative issues and make things simpler for enrollees.

Healthy behaviors will still be encouraged and incentivized, though in new ways.

'In this population, you have people who have not had regular dental care for a while or maybe ever,” Russell said. 'You need to help teach behaviors that many people know, but some of that is not a normal pattern of behavior for Medicaid members.”

Under the current program, those insured in the Dental Wellness Program have access to core services, including exams and cleaning as well as emergency services. But the plan incentivizes more complex work, such as restorative services, root canal care and gum treatment.

Those on the plan can earn these services by completing a recall exam within six to 12 months of their initial exam.

Starting July 1, those tiers will be eliminated.

Instead, all enrollees will have access to benefits for the first year where they will be asked to complete a dental self-assessment and preventive service, Lovelady said. If they complete those healthy behaviors, benefits will continue in the second year without a copay. If they don't, enrollees will be responsible to pay a monthly premium of no more than $3 per month.

Enrollees are able to declare a hardship and not pay that premium, Lovelady said. However, if they don't complete the healthy behaviors, pay the premium or mark a hardship, benefits will be more limited.

'We want to get them to be more involved in their health care, do more preventive services, and assist them in the long-run with oral and medical needs,” she said.

l Comments: (319) 398-8331; chelsea.keenan@thegazette.com