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Dental Summit

Dental Summit. Presented by: Sheldon Wolf Assistant Medicaid Director North Dakota Department of Human Services April 14, 2000. Medicaid in North Dakota. Eligible recipients per month 22,000 children 20,000 adults Fee-for-service program Use ADA claim form

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Dental Summit

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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 inNorth 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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