Kansas dental program for children on hold because of KanCare MCO

If state-run Medicaid had its problems, one part that was working well in Kansas was providing oral health care to kids through programs such as Kansas Cavity Free Kids, Head Start officials say.

By the fifth year of the pilot program, which began in 2007, more than 7,000 children in 41 rural counties had received regular cleanings, fluoride varnishes and sealants from dental hygienists in Head Start classrooms.

It worked so well that program officials planned to expand it to other areas of the state where access to dental care is chronically limited.

But the program was effectively shut down after the launch of KanCare on Jan. 1, when day-to-day management of the state’s Medicaid program was turned over to three for-profit managed care companies.

Kansas Cavity Free Kids began in the wake of reports of a severe and growing shortage of dentists.

Thousands of Kansans in rural areas of the state lack the ability to stop by a dentist on the way to work or school. In rural Kansas, it’s not unusual for parents to take a “vacation” day and pull their children from school to drive the whole family 60 miles or more to visit a dentist, say those from the western half of the state.

“Growing up out there, it’s just understood,” said Nathan Schmidt, a third year dental school student from Wallace county in northwest Kansas. “You take the entire afternoon off, or in the case of braces the whole day off.”

UnitedHealthcare, one of the three KanCare contractors, chose to not authorize payment for teeth cleanings performed at Head Start, a decision that effectively put the entire program on ice.

“United does not recognize (a hygienist’s) services if she’s working under Head Start for doing cleanings for kids or for pregnant women,” said Kathy Hunt, the Head Start official who coordinated Kansas Cavity Free Kids.

The other two KanCare companies — Amerigroup and Sunflower State Health Plan, a Centene subsidiary — continued the previous state policy of allowing dental care performed at Head Start facilities to be billed under Medicaid.

But Hunt said the program could not continue serving children covered by those companies while turning away others covered by United.

“Quite frankly, we have not provided services since” KanCare began, Hunt said. “We can’t say ‘I’m going to provide services for this child and not for this child.'”

Hunt also serves on the board of directors for Oral Health Kansas. She testified about the problem last month at the first meeting of the Legislature’s KanCare oversight committee.<a name=”continued”></a>

A month later, she hadn’t had any response from legislators, state officials or representatives of UnitedHealthcare.

Cleaning teeth in Head Start

Kansas Cavity Free Kids was a way to bring dental care directly to children by arranging for an oral hygienist, perhaps from another county, to travel to Head Start classrooms with a portable dental chair and teeth cleaning equipment for regular check-ups.

“Head Start doesn’t want to be in the dental business. What we were doing was filling a gap that was there,” Hunt said.

Before KanCare, the program operated in classrooms of five Head Start programs spanning 28 counties. The program also steered Head Start children in Riley County and in 12 southeast Kansas counties to area safety net clinics that provided dental care.

Head Start contracted with the hygienists, scheduled the appointments and billed Medicaid, now known as KanCare.

But most services are on hold while Head Start officials determine if the contracts and billing for the traveling hygienists can be shifted to cooperating safety net clinics or local health departments.

United reviewing its policy

Another possibility is that United could adjust its policy, something that now appears to be in the works.

Timothy Spilker — president of United’s Kansas health plan — told KHI News Service that the company initially set its billing procedures based on guidance issued by the state in 2011, but that the company’s policy wasn’t set it stone.

“It’s United’s understanding that any dental services provided in Head Start programs that were previously covered prior to KanCare should be covered now, as part of the MCO’s benefit package. We are in the process of working with the state to review our payment policies and coverage amounts to ensure that we are covering the appropriate Head Start dental services, since we realize this is a critical program to support children’s dental health.”

Spilker said he had intended to follow up with Kansas Cavity Free Kids last month after hearing about its concerns at the KanCare oversight committee meeting.

“I looked through the list of all the folks who testified and made the commitment that at some point we’ve got to reach out and really start connecting with folks. Part of it is that I’m new, so I’m still in the process of just getting ramped up and meeting folks,” he said.

Spilker began as the plan’s president in August.

Hunt said that although she hasn’t heard yet directly from United officials, she appreciates their apparent willingness to review the payment policies.

“We are eager to see all the dental services previously available to Head Start children through this program restored,” she said. “What we were offering was a way for kids who don’t have access to dental care to get it.”

More than preventing cavities

Health advocates have long argued that improved access to dental care provides many more benefits than healthier teeth, including:

• Fewer expensive emergency room visits for dental problems;
• Less need for advanced dental procedures, such as fillings, crowns and root canals;
• Fewer physical health complications;
• Reduced health care costs; and
• Improved ability for adults to gain employment and for children to concentrate at school.

“In Head Start, kids with poor dental health would sulk, they wouldn’t play, they would be aggressive or abusive to other kids. Fix their teeth and problem solved,” said Marcia Manter of Oral Health Kansas.

All three KanCare companies provide annual preventive cleanings for adults in their plans.

Prior to KanCare, only children were eligible for oral health care under Medicaid.

“Oral health is directly linked to physical health,” said Jean Rumbaugh, chief executive of Sunflower State Health Plan, one of the three KanCare companies.

“In extreme cases, if you have someone who isn’t getting their preventive dental care, ultimately that will end up in an (emergency department) visit for pain. And that ED visit is very expensive and doesn’t address the issue, whereas preventive care can address that issue up front to eliminate future physical health problems,” she said.