Minnesota Legislature Makes Historic Investment in Dental Care

08/30/2021 / Matthew Bergeron

Reimbursement rates for dental care in Minnesota’s Medicaid program (commonly referred to as Medical Assistance or “MA”), have long lagged national averages and resulted in decreased access to care for public health care program enrollees.  A 2018 study by the Health Policy Institute of the American Dental Association found that Minnesota ranked 49th out of 50 states for pediatric dental reimbursement and 47th in adult dental reimbursement.  Around that same time, the federal Centers for Medicare and Medicaid Services (“CMS”) issued a corrective action plan for Minnesota’s pediatric dental program, noting that in 2015, only 41% of MA-enrolled children received dental care and only 37% received preventive dental care (both well below national averages).

With the growing importance of the MA program in Minnesota’s health care landscape in the last decade, the Minnesota Legislature and officials at the Minnesota Department of Human Services (“DHS”) have wrestled with how to increase access to care.  Substantive reimbursement rate increases have been prohibitively expensive while regulatory reform proposals, including carving dental services out of the state’s existing managed-care program, have been met with concern from many high-volume, nonprofit dental clinics, particularly those historically eligible for the Critical Access Dental (“CAD”) rate add-on.  However, as billions of federal dollars flooded into Minnesota following the passage of the American Recovery Plan Act, the Minnesota Legislature identified a once-in-a-generation opportunity to move the needle and invest in the state’s MA dental program. 

The 2021 Omnibus Health and Human Services Finance bill appropriated $61 million in additional funds to increase the state’s MA reimbursement rates for dental care.  Effective January 1, 2022, this will result in an across-the-board increase of approximately 98%.  Additionally, while most of the historic rate add-ons (including the community-clinic, children’s and rural add-ons) will be absorbed into the new, increased base rate, CAD providers will continue to receive a 20% add-on, down from the historic 37.5% enhancement.

In addition to the substantial financial investment in the MA base rate, the 2021 budget bill also included a number of other provisions aimed at improving access to and the quality of oral health care in Minnesota, including:

  • Appropriating roughly $2.2 million a year to reinstate MA coverage of nonsurgical treatment for periodontal disease for adults.  This includes scaling and root planing once every two years and routine periodontal maintenance procedures.
  • Appropriating $41,000 in FY 22 to the Dental Services Advisory Committee (“DSAC”) to establish a dental home advisory committee to design a dental home demonstration project, modeled off of similar projects in the physical and behavioral health spaces, and to present the recommendations, including legislative language, to the Legislature by February 1, 2022.
  • Requiring health insurance companies to begin utilizing a uniform provider credentialing process beginning on January 1, 2022.
  • Requiring health insurance companies to make available to dental clinics, upon request, the fee schedule under which the provider is currently being reimbursed.
  • Requiring DHS to present recommendations on dental rate rebasing to the Legislature by February 1, 2022.  The recommendations must address the frequency of rebasing, whether rebasing should incorporate an inflation factor, and any other factors relevant to ensuring access to dental care.

While the final omnibus bill did not include the “carve-out” proposal promoted by both Gov. Tim Walz and the DFL-controlled House of Representatives, it did include compromise language that provides for a series of benchmarks intended to improve dental utilization in the Prepaid Medical Assistance Program (“PMAP”) that is currently administered by managed-care and county-based purchasing organizations.  Health plans that fail to meet those benchmarks will be required to submit corrective action plans and, if by 2024, the plans have collectively failed to meet the benchmarks, then DHS will enter into an agreement for a single dental services administrator beginning in 2026. 

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Do you have more questions on this topic? Reach out to Matthew Bergeron at 952.896.3203 or mbergeron@larkinhoffman.com.