1. K ENTUCKY Cabinet for Health and Family Services Kentucky Department for Medicaid Services Lisa D. Lee, Commissioner November 20, 2015

2. 2 Medicaid at a Glance 1.3 Million Members Managed Care Delivery System ACA Changes Medicaid Expansion State Based Exchange – kynect Streamlined Eligibility and Enrollment

3. 3 Medicaid Enrollment 2012-2015

4. 4 Expansion Demographics Average age = 38 Evenly distributed between males and females Under 138% of Federal Poverty Level - $16,105 per year Health Status –High Cholesterol –Diabetes –COPD –Asthma –Depression

5. 5 Overview of Selected Preventive Services Relative Increases in number of Medicaid screenings Pre-Expansion (2013) vs. Post-Expansion (2014) Smoking Obesity- Metabolic Cancer Cardio- vascular Dental MH Drug & Alcohol Overall Exams *Based Medicaid Claims Data

6. 6 Adult Preventive Dental Visits 2013 2014 117% 85,779 More Received Preventive Services

7. 7 Medicaid Paid Dental Services by Category SFY2009SFY2010SFY2011SFY2012SFY2013SFY2014SFY2015 CategoryTotal Spend Checkup/oral Evaluation$9,588,344$11,421,513$12,565,091$8,993,894$10,353,870$11,976,471$13,723,578 Dentures$110,174$99,388$115,992$62,763$41,709$41,652$44,361 Extractions$17,088,917$17,493,869$18,369,086$12,633,457$13,500,062$17,770,223$23,581,249 Gum Treatment/Gingivectomy /Debridement$3,188,629$3,351,197$3,687,230$2,134,566$1,682,975$2,280,412$4,094,162 Other$19,775,079$23,614,684$24,614,556$15,597,318$18,345,909$22,543,234$27,478,381 Preventive/Sealants/Clea nings$15,785,138$19,698,002$21,470,772$16,909,144$21,974,170$23,190,664$24,041,463 Prosthesis$17,163$15,962$15,857$8,991$4,137$2,344$777 Pulp Cap/Root Canal$4,278,946$4,252,226$4,077,407$2,860,812$3,083,581$2,944,465$2,929,443 Restoration/Crowns$5,026,268$5,578,092$6,009,033$4,317,920$5,228,747$5,717,563$6,240,392 Restoration/fillings$27,551,645$30,243,809$30,301,185$22,684,698$26,453,088$28,352,284$33,621,099 Space Maintainers/Retainers$796,420$872,668$907,706$653,071$776,400$714,259$617,649 Xrays/Bitewings/Panora mics$10,569,464$12,563,327$12,886,825$9,487,499$11,618,814$13,514,228$16,224,307 Grand Total$113,776,187$129,204,737$135,020,739$96,344,131$113,063,462$129,047,799$152,596,860

8. 8 Number of Medicaid Members Receiving Dental Services SFYDistinct Member Count (Under Age 19 Only) 2010244,113 2011262,074 2012247,055 2013261,082 2014274,411 2015282,171 SFYDistinct Member Count (All Ages) 2010333,573 2011351,982 2012327,451 2013343,297 2014402,518 2015470,380

9. 9 SFY 2007SFY 2008 Distinct Members Rcving Dental Service 172,589191,725 Distinct Members Enrolled During Timeframe 466,939482,659 Percent Utilizing37%40% What Happened When Kentucky Raised Dental Rates for Children by 30%?

10. 10 Summary Dental Health is Important to Physical Health Not Everyone has Dental Insurance Medicaid Covers 1.3 Million Members Medicaid Expansion Covers 427,000 People Medicaid Paid $152 Million in Dental Claims in SFY2015 Raising Dental Reimbursement Rates Did Not Appear to Result in a Large Increase in Utilization for Children Policy Changes Impact Services