Medicaid dental benefits cap delayed

July 19--State officials said Thursday a cap on dental benefits for Medicaid members will be delayed until the beginning of September.

The $1,000 annual dental benefit maximum will be implemented for every adult Medicaid member aged 21 and older -- including those members who receive coverage through fee-for-service and the Dental Wellness Plan -- starting Sept. 1.

Members will be subject to the cap on services through June 30, 2019.

There are 301,348 members in the Dental Wellness Plan, said Department of Human Services spokesman Matt Highland.

"This delay will allow a sufficient amount of time for the Iowa Medicaid Enterprise to identify and test program requirements for the dental carriers," Highland said. "These requirements will ensure the member's dental plan has the most current annual benefit maximum claims calculation to share with providers."

The benefit maximum previously was set to begin July 1.

The limit does not include preventive, diagnostic or emergency dental services, as well as anesthesia in conjunction with oral surgery and fabrication of dentures, according to the previous DHS announcement.

The cap would not include services such as annual checkups, cleanings, X-rays and fluoride treatments.

This decision comes nearly a month after the University of Iowa College of Dentistry program announced it no longer would accept new adult patients covered by Iowa's Dental Wellness Plan, dental coverage for Medicaid patients by private insurers Delta Dental and MCNA Dental.

"The University of Iowa is planning to move forward as previously communicated," university spokesman Anne Bassett said Thursday.

The state's only dental college called it quits at the beginning of this month due to concerns over recent changes to the dental program, including the $1,000 cap on dental services and reimbursement rates "so low for many procedures that they do not cover the actual lab costs."

"The management of the Dental Wellness Plan program has become so complicated that we no longer have the ability or resources to effectively oversee additional Dental Wellness Plan patients," said Michael Kanellis, the college's associate dean for patient care, in an email to Iowa Medicaid Enterprises.

It was similar concerns that led Dr. Thomas Grimes, a private practice dentist based in Marion, no longer to accept Dental Wellness Plan members beginning in January of this year. He still sees children covered by Medicaid, he said.

Grimes opted to stop seeing those patients after he said state health officials lowered the reimbursement rates for services such as cleanings and exams, which wellness plan patients must have to meet their coverage requirements.

"It was just one of those things where we were going to be non-profitable," Grimes said.

Some dental professionals in the Corridor still accept the state insurance, including Dr. Derek Peek, an endodontist who operates Eastern Iowa Endodontics with his father, Dr. Thomas Peek.

Peek said he didn't go to dentistry school and subsequent specialty training to become an expert "and only accept people who can afford (it)."

However, he acknowledges the challenges he and others in his profession face obtaining authorization or reimbursements from insurance companies for certain procedures.

"We're figuring out these new red tapes, but they're not making it any easy," Peek said.

For more information on the Dental Wellness Plan, go to dhs.iowa.gov/dental-wellness-plan.

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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