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Medicaid Presentation - Sheldon Wolf
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Medicaid Presentation - Sheldon Wolf

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  • 1. Dental Summit Presented by: Sheldon Wolf Assistant Medicaid Director North Dakota Department of Human Services April 14, 2000
  • 2. Medicaid in North Dakota
    • Eligible recipients per month
      • 22,000 children
      • 20,000 adults
    • Fee-for-service program
    • Use ADA claim form
    • Extra compensation for dentists who treat DD clients
    • Prior authorization for prosthodontics, orthodontics, and oral surgery
  • 3. Medicaid in North Dakota
    • Electronic claims submission available
    • Claims turn around 10 days
  • 4. Medicaid Dental Benefits
    • Children ( Age 0-21 years)
      • Covered under EPSDT (Health Tracks)
        • diagnostic
        • preventive
        • restorative
        • limited orthodontics
        • limitations on endo, prostho, perio, and oral surgery
        • cleft lip/palate treatment covered
      • Reimbursement - 85.7% of billed charges
  • 5. Medicaid Dental Benefits
    • Adults (over 21 years of age)
      • Covered services
        • Diagnostic
        • Preventive
        • Restorative
        • Some limitations on endo, prostho, and oral surgery
        • Periodontal treatment
      • Reimbursement - 72.3% of billed charges
  • 6. Medicaid Dental Strategies to Improve Access
    • Major fee increase in Dec. 1997
    • (shown in billed charges)
      • children - 70.7% to 85.7%
      • adults - 65.5% to 72.3%
    • Result
      • Increase in provider participation rate - 3.4%
      • Percentage increase in number of recipients served - 14.6%
      • Percentage increase in of number of services provided - 14.3%
    • Net Result - stabilization of the program
  • 7. Current Medicaid Dental Statistics
    • Annual budget - $4.95 million
    • 2000 Projected Expenditures - $5.4 Million (13% Increase from 1999)
    • Medicaid Recipients - 42,000
    • Average Number Receiving Dental Services a month - 2,720 (6.5%)
    • 19,707 recipients received service in calendar year 1999
      • 10,894 Children
      • 8,813 Adults
    • Average Cost Per Recipient - $326
  • 8. Healthy Steps Information
    • April Enrollment - 1,524
    • October - November 1999
      • Average Enrollment - 448
      • Preventive Services - 252
      • Restorative Services - 53
      • Periodontics/Surgery - 14
      • Other - 44

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