How Md. Medicaid Saved Millions

[hummingwolf]

In case anyone's wondering why I keep trying to figure out how to get dental care when I already know about the local dental school and, gosh, maybe I should be satisfied that that's the best I can do:

Maryland Medicaid saved millions of dollars by ending reimbursement of dentists for treating adult dental emergencies

The Maryland Medicaid program eliminated reimbursement to dentists, but not to physicians or hospitals, for treating adult dental emergencies in 1993. By 1995, 2 years after this change in reimbursement, Medicaid costs for adult dental care claims plunged to zero from more than $7.5 million in the 2 years preceding the change. Medicaid reimbursement for routine adult dental services was eliminated by the State in 1976.

Surprisingly, Medicaid costs for emergency dental care for adults also dropped significantly in every other care setting, generating an additional $232,470 savings during the post-change period (1993-1995). For instance, emergency department (ED) costs for dental emergencies dropped 10 percent from $723,835 to $651,649, even though the number of ED claims rose from 2,081 in the pre-change period to 2,245 in the post-change period. The largest drop in costs was seen in physician-linked ED claims, which dropped nearly 69 percent from the pre-change to the post-change phase. Thus, Medicaid's goal to reduce dental costs was achieved but perhaps at a price, suggests Richard J. Manski, D.D.S., M.B.A., Ph.D., Dental Scholar-in-Residence at the Agency for Healthcare Research and Quality.

Dr. Manski and his colleagues point out that disadvantaged patients may have been confused by the policy change, perhaps believing that Medicaid would not cover any care for dental emergencies. They likely suffered poorer health outcomes and paid for emergency dental treatment out of pocket, found free clinics, or received free care from generous dentists. These findings are based on analysis of Maryland Medicaid data on ED and other provider claims by adult Medicaid patients for the treatment of mouth pain and infections associated with the teeth and periodontal tissues during the 4-year period from February 16, 1991 to February 15, 1995.

Disadvantaged patients may have been confused? How about everyone I've spoken to at social services, the county health department, the state dental association, the hospital emergency room, my primary care provider's office, and every other place I have been to or called up in the last few weeks? If Medicaid patients are supposed to be able to get "treatment of mouth pain and infections associated with the teeth and periodontal tissues" why is it that nobody has told me how?! The only advice I have managed to get from any of these people who should know has been along the lines of "pa[ying] for emergency dental treatment out of pocket, f[inding] free clinics, or receiv[ing] free care from generous dentists." Is anyone really surprised that patients might be confused?

Have I mentioned lately how much I hate bureaucracy? 'Cos I really, really hate bureaucracy.

Comments

[hai-kah-uhk.livejournal.com]

That bites. I've dealt with bureaucrappic idiocy before, but that beats all I've seen.

[hummingwolf.livejournal.com]

It beats *all* you've seen? While it's bad, I have the feeling you have encountered worse. Then again, maybe you're repressing, in which case I'll shut up now. :-)

[hai-kah-uhk.livejournal.com]

Actually, no. The worst I've seen is government employees being completely unable to take "I'm not disabled and I don't want your money" for an answer. There's also the IRS's habit of failing to acknowledge I exist, which is inconvenient but primarily just funny. Other than that, I've almost always had shrinks as go-betweens, and while the experiences with shrinks were pretty thoroughly rotten, they themselves weren't part of the government. If the government pulled anything stupid during that whole fiasco, I never heard about it. I didn't ask, either.