Tennessee Plans To Move TennCare Dental Benefits for Children into Separate Program

To increase the number of children who receive dental care through TennCare, Tennessee's Medicaid managed care program, the state plans to carve out the benefits into a separate program and hire a managed care organization to design and operate it, the Nashville Business Journal reports. Several MCOs currently provide dental benefits for TennCare children, but under the state's plan, one dental benefit management company would be required to pay providers and collect premiums, as well as to increase the number of participating dentists and utilization of dental benefits. Before TennCare began in 1993, about 1,000 dentists participated in the state's previous Medicaid program, but since that time, the number of dentists in the program has dropped to about 200. Many providers have ended their participation because of what they say are low reimbursement rates; dentists currently are paid about 40% of the cost for each procedure administered to a TennCare beneficiary, according to David Horvat, executive director of the Tennessee Dental Association. Although Horvat said the state's plan to increase provider participation and beneficiaries' utilization "makes ... sense," he suggested that the dental benefit manager would end up spending an equal amount on care and administration costs. He added that the dental benefit manager is "obligated to increase utilization" but also would be tasked with keeping costs low. "If you increase utilization, you're going to drive yourself out of business," he said. MCOs have until April 11 to submit a proposal for the dental management contract. The projected start date for the contract is July 1 (Raiford, Nashville Business Journal, 4/4).