Kids' dental care - OUR OPINION MEDICAID HMO PILOT WITH DISPUTED RESULTS IS UNACCEPTABLE
Results of the state's dental HMO experiment for children on Medicaid are in, but they don't show if the new approach is better than the old. That's unacceptable. The project was to improve access to dental care for 200,000 Miami-Dade children on Medicaid, reducing fraud and state costs in the process. The idea was to switch them to HMO coverage in 2004 and away from standard fee-for-service Medicaid.
Now, a University of Florida study reports disturbing results for the pilot's first year, which ended in June 2005. It found the number of poor children seeing a dentist dropped 40 percent. Only 27,000 children got dental care, a drop of 35,500 from the previous year under the old program. Also, children received only $2.1 million in dental services while the state paid $15.3 million to Atlantic Dental, the HMO running the pilot.
Florida Medicaid Director Tom Arnold disputes those numbers. He says that the baseline figures of dental care are inflated by fraud and that the results are understated because Atlantic Dental and its dentists underreported services rendered. But by the state's own estimates, there is at most 10 percent fraud and abuse in Medicaid billings. And a state Senate staff report noted that fraud happens in managed-care services, too. [ read full article ]
Kaiser again offers many free health tests Sunday Checkups include vision, dental, blood pressure, diabetes, prostate cancer
Parents always have to arrange for a medical exam and immunizations before putting a child in school.
Try doing that for eight children after school is in session.
That was the problem in August 2005 for Constantina and Siegfried Guentensperger, who moved to Modesto with their four children after living for seven years in Switzerland. The parents also are raising the four surviving children of Constantina's late sister from Oregon.
"The children needed their immunizations and we had very scant records for them," said Constantina Guentensperger, who is a California native. "The school (officials) said we needed to have this and that before they could come back to school."
The Kaiser Permanente Neighbors in Health event, held the third Sunday of every August, became their solution.
The eight children, ages 5 to 13, went from table to table at the 2005 health fair, getting immunizations and medical exams, and having their teeth and eyes checked. They also had lunch and enjoyed hearing about snakes and lizards from a reptile expert. [ read full article ]
Dental HMO flawed, study finds Columbia University reports a Medicaid pilot project is not justifying its budget, while the dental providers complain that the fee level is low
While Atlantic Dental insists it's doing a good job providing care to poor kids in Miami-Dade County, a study just released by Columbia University concludes the Medicaid pilot project has cost taxpayers "the same amount for less care and less quality."
The study by Burton L. Edelstein, a professor of health policy, reports that in the first year of the pilot the dental budget for Medicaid in Miami-Dade increased 1 percent (from $14.9 million to $15.1 million) while the average number of annual dental visits per enrolled child dropped by 61 percent.
Meanwhile, one of the largest providers of dental services under the program, the Community Health of South Dade Inc., known as CHI, said it planned to drop out of the program and no longer serve the dental needs of 6,000 Medicaid kids because the plan pays only $4.25 per child per month.
"We can't continue to provide service for that amount," said Brodes Hartley Jr., CHI's chief executive.
Lourdes Tome-Rivas, vice president of operations for Atlantic Dental Inc., or ADI, said the company is being unfairly criticized. The measured drop in services is caused by dentists not reporting all the work they do, she said. They have little motivation to report what they do because they get paid in advance, whether they perform the work or not. [ read full article ]