Medicaid Presentation - Sheldon Wolf

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Medicaid Presentation - Sheldon Wolf

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

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