Dental Summit Presented by: Sheldon Wolf Assistant Medicaid Director North Dakota Department of Human Services of Human Services April 14, 2000

Medicaid in North Dakota b Eligible recipients per month 22,000 children22,000 children 20,000 adults20,000 adults b Fee-for-service program b Use ADA claim form b Extra compensation for dentists who treat DD clients b Prior authorization for prosthodontics, orthodontics, and oral surgery

Medicaid in North Dakota b Electronic claims submission available b Claims turn around 10 days

Medicaid Dental Benefits b Children (Age 0-21 years) Covered under EPSDT (Health Tracks)Covered under EPSDT (Health Tracks) –diagnostic –preventive –restorative –limited orthodontics –limitations on endo, prostho, perio, and oral surgery –cleft lip/palate treatment covered Reimbursement % of billed chargesReimbursement % of billed charges

Medicaid Dental Benefits b Adults (over 21 years of age) Covered servicesCovered services –Diagnostic –Preventive –Restorative –Some limitations on endo, prostho, and oral surgery –Periodontal treatment Reimbursement % of billed chargesReimbursement % of billed charges

Medicaid Dental Strategies to Improve Access b Major fee increase in Dec (shown in billed charges) (shown in billed charges) children % to 85.7%children % to 85.7% adults % to 72.3%adults % to 72.3% b Result Increase in provider participation rate - 3.4%Increase in provider participation rate - 3.4% Percentage increase in number of recipients served %Percentage increase in number of recipients served % Percentage increase in of number of services provided %Percentage increase in of number of services provided % b Net Result - stabilization of the program

Current Medicaid Dental Statistics b Annual budget - $4.95 million b 2000 Projected Expenditures - $5.4 Million (13% Increase from 1999) b Medicaid Recipients - 42,000 b Average Number Receiving Dental Services a month - 2,720 (6.5%) b 19,707 recipients received service in calendar year ,894 Children10,894 Children 8,813 Adults8,813 Adults b Average Cost Per Recipient - $326

Healthy Steps Information b April Enrollment - 1,524 b October - November 1999 Average Enrollment - 448Average Enrollment Preventive Services - 252Preventive Services Restorative Services - 53Restorative Services - 53 Periodontics/Surgery - 14Periodontics/Surgery - 14 Other - 44Other - 44