Detroit —February 22, 2023 —With the public comment period now closed, reimbursement enhancements that will pump more than $85 million into dental care are on track for implementation effective April 1, 2023. It’s an increase that will ultimately prove to be an expansion of dental care for 800,000 Medicaid participants in Michigan. For Detroit-based DENCAP Dental Plan President and owner Joseph T. Lentine, Jr., the change represents a milestone in the company’s efforts to increase access to dental care for residents lacking both oral health services and an understanding of the critical link between oral and physical health.
While dental benefits have been available for adult Medicaid recipients for decades, the rates of reimbursement have been so low that the majority of dentists cannot afford to service Medicaid patients, Lentine explained, effectively barring recipients from coverage. For example, prior to the benefit enhancements slated to go into effect April 1, the state reimbursement for fillings did not even cover the cost of materials. As part of the re-design of Medicaid-funded adult dental services, new reimbursement rates for dentists and specialists will be on par with commercial coverage.
According to Lentine, there are already several social determinants of health that impede access to dental care for Michigan’s low-income residents. Proximity to dentists and transportation limitations are key factors, but there are also ingrained behavioral considerations, such as fear of the dentist, no established relationship with a dentist, a lack of understanding on the role of oral health in overall health and wellness, and a multi-generational mindset on all of the aforementioned.
“For too many Medicaid recipients, dental care – when sought at all – has been prompted by excruciating mouth pain that sends them to the emergency room for relief. With limited to no routine dental care, there is also no opportunity to check for serious medical conditions such as heart disease or diabetes that may also present in the mouth,” Lentine said. “These enhanced dental benefits should ultimately result in a corresponding boost in the health of those who use them, but the expansion will also require a multi-faceted, ongoing education campaign to be truly successful.”
Lentine and DENCAP Executive Vice President Dawn Dorsch made several visits to Lansing in the spring and fall of 2022 to meet with legislators and educate them on the shortcomings of the current Medicaid dental coverage and its health impact on constituents. Their goal was to encourage the state to hold off on the claw back of funds expected for dental managed care organizations in April 2023 and also use federal matching funds – which were use it or lose it funds – to expand access to dental benefits in a meaningful way for Michigan’s 800,000 Medicaid recipients.
“Most legislators were not aware of the woefully limited reimbursement levels for Medicaid dental benefits and the ripple effect on dentists and ultimately patients,” Lentine said. “They were definitely open to change. Frankly, the swiftness of the process to the point where reimbursements will be boosted a year after our efforts began is a reflection on the understanding that the current dental program was simply not working.”
DENCAP’s diligence was shared by Dominick Pallone, Executive Director of the Michigan Association of Health Plans. He joined Lentine and Dorsch in pushing for the state to administer the new enhanced benefit plans through existing Medicaid insurance partners rather than putting it out for bid – a process that would have likely taken another year to launch and complete.
“The State’s existing Managed Care Organizations are already serving these members with their health coverage, and adding the dental benefit as expanded coverage not only allows for quick implementation, but more importantly, integrates the oral health with the overall health of the member,” Pallone said.
While the enhanced dental benefits will likely bring more members to DENCAP and the state’s other participating dental insurers, it’s the patients who will benefit from better care and dentists who will be reimbursed appropriately for their time and skill.
“The Medicaid enhancement will not be a bonanza for DENCAP or any of the other insurers,” Lentine said. “Our push in Lansing has always been about increased access to dental care and understanding the link between integrated dental care and healthcare. It’s been part of DENCAP’s mission since my father Joe Lentine Sr. founded DENCAP in Detroit in 1984 to bring affordable dental care to city residents. Nearly 40 years later, our reach has expanded, but the goal of quality, affordable care remains the same.”
With an enrollment of more than 200,000 members, DENCAP’s customer base includes multiple municipalities, governmental units, and union locals, as well as a variety of small and medium-sized businesses and individuals. In January 2023, the company announced the purchase of Warren-based Golden Dental Plans. DENCAP also provides services to the State of Michigan’s Medicaid and Healthy Michigan programs and the Healthcare.gov Marketplace.
DENCAP is a member of the National Association of Dental Plans, the Michigan Association of Health Plans and the Metro Detroit Association of Health Underwriters. It is actively engaged in the community and started a nonprofit organization with Detroit Kiwanis Club #1 called Books for Kids in 2001 with the belief that reading is the key to a meaningful future. The nonprofit collects over-runs from publishers and new book donations and distributes them to school-age children throughout Detroit. To date, more than two million books have been donated to metro-Detroit children through Books for Kids.
About DENCAP Dental Plans
Founded in Detroit in 1984 with a mission to provide dental coverage for all, DENCAP is a licensed insurance business with the State of Michigan and offers affordable and comprehensive Dental Health Maintenance Organization (DHMO) and Point of Service (POS) plan options for groups, families and individuals. Working with State of Michigan sponsored health plans, DENCAP also services the Healthy Michigan Medicaid population as well as the national Healthcare.gov Marketplace.