Children & Medical Assistance

October 20th, 2016 - By steve.mccormack

 

ma-kid

 

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For Children enrolled in the Wisconsin  Medical Assistance Program … age 20 or less.

Through a special pilot program, 4 counties in Wisconsin are experimenting with much improved reimbursement rates to dentists providing dental care to children.  Because of that, we are now able to see many more MA children at our office.   The program was very seriously underfunded and the state legislature is trying the approach used in Michigan to see if dentist participation increases …. and more children are cared for.  Give us a call and maybe we can help your child.

Why Don’t Dentists Take Medical Assistance?

October 31st, 2013 - By steve.mccormack

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… An important question we are asked a lot.

As you might already know, it’s because the medical assistance program is broken like so much of our health care system.

For starters, MA reimburses at about 35% of dentist’s fees.   In our case our fees are, on average, 25-50% less than dentists in the MPLS-St Paul area so you can see how bad the reimbursement rate is. Unfortunately though, every hospital, nursing home, pharmacist and more are crying over the poor rates too. But it’s not just about the money.

Paperwork can be a bear, too. There are restrictions, pre-approvals and more that un-necessarily complicate things. Things have improved significantly with electronic records and on-line capabilities though.

Unfortunately too, is the reality that MA patients, when they are able to find a dentist taking MA, fail their appointments more than most.

So, the “government” decided one fix was to create FHQC … federal health qualified centers. These are brand new larger clinics with dentists who see MA patients and non-MA patients alike. The goal was to get care to the MA patients … a noble one … but in my view a poor one. These all new clinics are built with mostly federal funds, get much higher cost based reimbursement rates, offer loan forgiveness to new dentists, and receive operating grants.

For Polk County residents, the closest ones are in Rice Lake and Chippewa Falls. Even worse is that they have stated they will no longer take Polk County residents! I thought these were federally funded clinics in part? So MA patients with toothaches go to the emergency room at the local hospital and simply receive antibiotics and pain pills, which do very little to help. It’s expensive government reimbursed care that could be better used elsewhere.

The thinking has always been that if the reimbursement rates were a little better, most dentists would accept MA and none of the FHQC would have had to have been built … and maybe emergency room visits would go down.

So what does our office do to help? We do not accept MA patients for comprehensive care. However we do see some emergency only patients, especially children. We also donate care in some cases.

Of note too … Since we are an MA provider we are obligated by the MA program not to accept private pay for dental care. That means that even if an MA patient wants to pay for it all themselves, we cannot accept that. A non-MA provider can take private money. We have to bill MA for anything we do and accept that as final and total payment.

It’s all so frustrating. The MA system is a poor one, and too many dentists regrettably won’t even offer occasional emergency care. I wish it were better.

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