Health

University of Iowa's dental college no longer accepting new Medicaid members

Program heading to 'a crisis situation,' says university official

Dental assistant Sherry Ryan (from left), Chong Shao, a fourth year dental student, and dental assistant Kelli Purkapile work on Mildred Swartzendruber during a visit by the University of Iowa College of Dentistry Geriatric Mobile Dental Unit (GMU) at Pleasantview Home in Kalona on Thursday, March 6, 2014. (Stephen Mally/The Gazette)
Dental assistant Sherry Ryan (from left), Chong Shao, a fourth year dental student, and dental assistant Kelli Purkapile work on Mildred Swartzendruber during a visit by the University of Iowa College of Dentistry Geriatric Mobile Dental Unit (GMU) at Pleasantview Home in Kalona on Thursday, March 6, 2014. (Stephen Mally/The Gazette)

IOWA CITY — Citing changes that will lead the state’s health care program to “a crisis situation,” the University of Iowa College of Dentistry announced Thursday it will no longer accept new adult Medicaid members for dental services.

University officials said the college will continue to serve its more than 8,000 current adult patients, but will not be accepting new adult patients covered by Iowa’s Dental Wellness Plan as of July 1.

“The management of the Dental Wellness Plan program has become so complicated that we no longer have the ability or resources to effectively oversee additional Dental Wellness Plan patients,” said Michael Kanellis, the college’s associate dean for patient care, in an email to Iowa Medicaid Enterprises.

The Dental Wellness Plan, available for Medicaid members aged 19 and older, covers most of the 600,000 poor or disabled Iowans on Medicaid.

The College of Dentistry — the state’s only dental college — saw 10,441 Dental Wellness Plan patients in the past fiscal year, for a total of 34,719 appointments.

The move “will undoubtedly have a significant impact” on Iowans and puts “the entire program closer to a state of crisis,” said Laurie Traetow, executive director of the Iowa Dental Association.

In a letter to Iowa Medicaid Enterprise Dental Director Heather Miller Wednesday, the college’s Kanellis cited concerns that recent changes to the dental program “will have significant educational, operational and financial impacts on the college.”

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“The state of Iowa used to have the best adult dental Medicaid program in the country, with the highest levels of dentist participation,” Kanellis said in his letter.

“We are concerned that the changes that have been made recently will effectively eliminate access to care for many patients enrolled in the Dental Wellness Plan and will lead to a crisis situation for many patients in the state.”

Reimbursement rates “so low for many procedures that they do not cover the actual lab costs” and a $1,000 maximum cap on services per patient in the Dental Wellness Plan have had a major effect on the college, Kanellis said in the letter.

“I don’t think you will meet many providers who are satisfied with rates, but our concern is that the program has become administratively unworkable for our members, most of whom are organized as operator-managed small businesses,” Traetow said in an email.

Department of Human Services spokesman Matt Highland said in an email to The Gazette that it was determined last year changes were necessary “improve and simplify” the program.

“The dental carriers are required to maintain network adequacy and we will continue to work closely with them, as well as the University of Iowa College of Dentistry to address their concerns,” he said.

The benefit cap includes several expectations that ensure patients get the services they need, Highland said in the email.

The combination of populations that changed the reimbursement rate “was done to address an inequity in provider reimbursement between Medicaid populations.”

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“We had two different groups for which providers were reimbursed at different rates,” Highland said. “We combined these groups to ensure we reimburse providers the same, regardless of which Medicaid members they are serving.”

In his letter, Kanellis said the requirement for a “Healthy Behaviors” assessment has been difficult for patients and college administrators to understand. It seems likely, he said, a majority of patients will not complete the requirement, therefore making them ineligible for anything but emergency services.

But Highland said the assessment was necessary to encourage members to use their full dental benefits. The previous plan had very few members advancing in the program and was an administrative burden on dentists.

These policies further aggravated the college as many dental providers statewide opted not to accept Medicaid patients or to drop out of the Dental Wellness Program completely, he added.

Kanellis had pointed out many patients will drive long distances to the college as they can’t find a dentist in their hometown who accepts Medicaid — even for emergencies.

“As a result, the wait time for appointments in some of our clinics is now excessive,” Kanellis noted in his letter.

These issues have even manifested themselves in extreme cases. Twice, the letter said, university officials have heard from relatives of patients who say they rely on street drugs to manage their dental pain.

“The governor’s office just received the letter (Thursday) and is working with the Department of Human Services to better understand the University of Iowa’s concerns,” said Brenna Smith, spokeswoman for Gov. Kim Reynold’s Office, in an email to The Gazette.

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But based what the Iowa Dental Association officials have been hearing from dental providers, they believe the program is not sustainable.

“Sustainability must be viewed not just through the lens of a provider, but certainly the lens of the taxpayer and the members,” Traetow said in an email to The Gazette. “We feel it is important to strike an appropriate balance and right now, we feel that balance has yet to be found.”

The College of Dentistry will continue to accept new adult patients in the geriatric and special needs clinic, university spokeswoman Jeneane Beck said.

Traetow said the Iowa Dental Association has been in conversation with Gov. Kim Reynolds’s administration “in an effort to balance the interests of all stakeholders.”

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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