Michigan Expands Medicaid To Give More Kids Dental Coverage

Michigan has proposed Medicaid policy to increase access to dental services for children by expanding participating Healthy Kids Dental counties from 75 to 78 counties. Healthy Kids Dental uses the Delta Dental provider network. The Legislature appropriated $11.6 million and selected the counties to be included in this expansion.

Effective October 1, 2013, as required by the Public Act 59 of 2013, the Michigan Department of Community Health (MDCH) will expand the Healthy Kids Dental contract with Delta Dental Plan of Michigan to administer the Healthy Kids Dental benefit in Ingham, Ottawa, and Washtenaw counties.

My question is if there is going to be a universal cost reimbursement system for all the counties. 

It has previously been raised that there are extreme disparities in Medicaid payments to dentists in Wayne and other heavily populated counties.  For Wayne County, there are many dentists who have told me they are better off not providing Medicaid dental services to children because the cost reimbursements were at levels of ten cents on the dollar.  In some instances it actually cost the dentist to provide child welfare dental services.

For this reason many dentists will not locate in Wayne County, or more so, the metropolitan Detroit area because it is financially impossible to operate a profitable practice. 

Children are the ones who loose out as studies have shown there is a direct correlation between dental hygiene and learning.  Simply put, if your teeth hurt that's where your attention is focused.

I have not  yet to inquired on the publication of payment rates.  Previous responses from the state have stated that there are no such records.  There should be no reason why Wayne County kids do not get the opportunity for the same dental treatments.  I hope changes have been made in this regard.


Michigan Child Welfare Dental Medicaid Expansion Policy

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Obamacare Forces Michigan To Stop Medicaid Fraud

Michigan has been forced to adopt a policy to stop Medicaid fraud under the provisions of the Patient Protection and Affordable Care Act (aka Obamacare) and Small Business Jobs Act.

With Michigan's contractual arms twisted behind its back, here are the proposed policies to force Michigan to end Medicaid fraud, even in child welfare.

The only concern I have is to question if there is a referral process to the State Attorney General Medicaid Fraud Control Unit (MFCU).  If there is, how is it there is to be review of questionable billing claims in child welfare when the State Attorney General is obligated to advocate for the ones who are generating the questionable billing.  If, in the miraculous event, there is successful identification of questionable and/or improper billing, will these contracted child welfare organizations have license revoked or be contractually debarred and published on the public sanction list.

In addition, regarding the predictive modeling, will the state set up any form of dispute resolution function for providers, mainly dental providers, who will experience the extreme financial burden of having Medicaid reimbursements suspended during the investigative process and incur substantial legal fees challenging situations like medical coding.

Lastly, there needs to be addressed the Medicaid reimbursement disparities of dental services in regions known to have high concentrations of economic distress.  Some have purported findings that these disparities in Medicaid dental rates to be racially charged based upon demographic data but greatly I enjoy elevating disputes from the realms of an ad hominem and call it what it is.

The Medicaid dental disparities of rates is subject to further examination.  Stay tuned.
Michigan Medicaid Claim Predictive Modeling Policy Michigan Medicaid Sanction Provider Notification Process Policy Voting is beautiful, be beautiful ~ vote.©