UI dental school to turn away new Medicaid patients because of low payments, confusing rules

Tony Leys | The Des Moines Register

The University of Iowa’s dental college plans to turn away new patients covered by Iowa’s Medicaid program because of frustration over low payments and increasingly convoluted rules, university officials said Thursday.

The UI runs Iowa’s sole dental college, and it takes on many patients with complicated dental problems. It will continue to serve existing patients.

The dispute pits state administrators at the university against their counterparts at the Iowa Department of Human Services. It is the latest skirmish in the bitter controversy over whether Iowa should have private companies run its $5 billion Medicaid program.

"The decision of the college rapidly moves the entire program towards a state of crisis," Laurie Traetow, executive director of the Iowa Dental Association, said Thursday.

Leaders of the college decided that next week, it no longer will routinely accept patients covered by Iowa Medicaid’s “Dental Wellness Plan.” The plan covers most adults who are among the 600,000 poor or disabled Iowans covered by Medicaid.

UI says crisis brewing; Reynolds looking into concerns

Michael Kanellis, associate dean of the dental college, spelled out the school's concerns in a letter Wednesday to Heather Miller, who oversees dental services for Iowa’s Medicaid program.

“The state of Iowa used to have the best adult dental Medicaid program in the country, with the highest levels of dentist participation," Kanellis wrote. "We are concerned that the changes that have been made recently will effectively eliminate access to care for many patients enrolled in the Dental Wellness Plan, and will lead to a crisis situation for many patients in the state."

Kanellis wrote that the Medicaid dental plan is paying less for dental services than it used to, and that it has added confusing rules for patients and dentists. One of the rules is a new $1,000 annual limit on non-emergency dental treatment covered by Medicaid.

“This will severely limit the care we can provide, the experiences our students receive and significantly reduce our clinic revenue,” Kanellis wrote. “Additionally, there is no indication how we can track the status of patients toward their $1,000 maximum, especially if referred from outside the college.”

Kanellis wrote that the college's clinics served 10,441 Dental Wellness Plan patients in the past year, for a total of 34,719 appointments.

Department of Human Services spokesman Matt Highland said Thursday afternoon his agency would work to address the concerns of the dental college and ensure patients have an adequate network of dental clinics accepting their Medicaid insurance.

Highland said the new Dental Wellness Plan was an improved and simplified program for adult Iowans on Medicaid.

Highland said the new $1,000 annual cap on non-emergency services is consistent with other plans, including the state employees’ health insurance plan and the Hawk-I plan for children from moderate-income families.

He said the department had streamlined the “healthy behaviors” rules to make them easier to understand. He also said the agency re-figured payment rates so all dental providers would be paid the same for their services to Medicaid recipients.

Republican Gov. Kim Reynolds' spokeswoman, Brenna Smith, said her office was looking into the situation.

"The governor’s office just received the letter today and is working with the Department of Human Services to better understand the University of Iowa’s concerns," Smith wrote in an email to the Register.

University spokeswoman Jeneane Beck said Thursday that the dental college would continue serving more than 8,000 adult Medicaid patients it currently has on its rolls. It also will continue to see Medicaid patients for emergency treatment of pain or swelling, and it will still accept new patients in its geriatric clinic and “special needs” clinic, which treats many people with disabilities. In addition, the dental clinic at the University of Iowa Hospitals, which is separate from the dental college, will continue to accept new adult Medicaid patients, she said.

Iowa children on Medicaid are not included in the current controversy.

Unpaid bills and contract language have long plagued dentistry program

The University of Iowa Hospitals has complained before about financial losses due to millions of dollars in unpaid bills under private management of Medicaid's coverage of medical care. Iowa Medicaid's dental program is managed by Delta Dental and MCNA, which are separate companies from the two firms, UnitedHealthcare and Amerigroup, managing most medical services. Many medical and social-service agencies have complained about red tape and unpaid bills from those two management firms.

The Iowa Dental Association complained last year that new contract language would no longer allow dentists to limit how many Medicaid patients they accepted. The association predicted many dentists would drop out of the program rather than accept unlimited numbers of money-losing cases.

Kanellis, the University of Iowa associate dean, wrote Wednesday that many other dental clinics around the state have stopped accepting new adult Medicaid patients because of the changes. That puts more strain on the dental college and increases patient waiting lists, he wrote.

“We are hearing from patients statewide who are not able to access dental care even for emergencies in their home town. Twice we have heard from relatives of patients who claim they have had to rely on street drugs to manage their dental pain,” he wrote.

Kanellis also complained that a “healthy behaviors” requirement placed on patients last year is confusing. Patients have been required to complete “oral health self-assessments” and “preventive service” or face limits on their dental benefits for fiscal year 2019, which starts Sunday.

“The healthy behaviors requirement has been difficult for both the collegiate administration and patients to understand (especially the health risk assessment). It will be very challenging for our clinics to track the status of these patients,” he wrote.

Traetow, of the Iowa Dental Association, said the Medicaid plan now pays dentists just $27 for a cleaning, which is significantly below cost. In some cases, she said, the state pays more to transport a patient to the dentist's office than it pays for the care provided there.

"This is a prime example of dentists effectively subsidizing the system by performing a service at an unsustainable rate of reimbursement," she wrote to the Register.

Traetow added that her group has talked to Gov. Kim Reynolds' staff about the problems, and the conversations have been "constructive."