ST. PETERSBURG — Seven-year-old Ebony McCray arrived at the dentist's office last week needing two crowns and four fillings.
She left needing a new dentist.
Dr. Myles H. Levitt has dropped out of the children's Medicaid program after the state shifted all dental patients into a controversial private managed care program. Dentists who take Medicaid were already a rare breed, and Ebony's parents don't relish searching for a new one.
"It's going to be a challenge, you know, but you've got to do what you've got to do for your children," said her mother, Kierra Mitchell, who has been trawling through phone book listings.
Florida has long done a dismal job in getting dental care to its poorest children. Nearly 76 percent of Florida children enrolled in Medicaid, the federal-state insurance program for the poor, received no dental care in 2011, putting Florida dead last among states, according to a new study by Pew Charitable Trusts.
But some dentists warn the state's efforts to save money could make a bad situation worse for children like Ebony.
As of today, two managed care companies will handle dental services for most of the 1.5 million children enrolled in Medicaid. Dentists say those companies — DentaQuest and MCNA Dental — are delaying care with a cumbersome payment system and a new credentialing requirement that takes up to six months.
Levitt and others say they're abandoning the system because of those hassles. His office, Dentistry for Children and Teenagers, has been taking Medicaid for nearly 40 years. Now its more than 6,000 Medicaid patients must find new dentists.
"This is much worse, much bigger, much more disastrous to the children of our state, our city, than the fluoridation issue," Levitt said, referring to the battle when Pinellas County stopped then restarted adding the tooth-saving mineral to its water.
State Sen. Alan Hays, an Umatilla Republican and retired dentist, said he's heard from dental colleagues that the companies have denied legitimate claims, such as certain X-rays for new patients. He said he regrets voting for the managed care system, which he calls "an embarrassment and a nightmare."
Asked if it makes him rethink the state's even bigger move — shifting all Medicaid medical services into managed care by next year — he said: "It sure does."
"The premise is that this managed care thing will save money," Hays said. "I think it's a bunch of baloney."
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The Florida Agency for Health Care Administration, which oversees the program, said it has received only 38 complaints from dentists about the managed care program over the past year, according to spokeswoman Shelisha Coleman. A top executive with one of the two managed care companies said many dentists have simply not adjusted to the increased scrutiny.
Carlos Lacasa, a senior vice president with MCNA Dental Plans, said the state had long allowed payments to dentists that a bottom-line oriented company like his would question.
"The fee-for-service system is woefully, woefully vulnerable to fraud, waste and abuse," said Lacasa, a former state legislator who is now chairman of the state-run Citizens Property Insurance Corp. board of governors.
Lacasa said the problem is that Florida doesn't spend enough for dental care: Out of a $22 billion Medicaid program, less than $200 million goes to dentistry.
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Florida began operating the so-called prepaid dental plans in Miami-Dade County nearly a decade ago. In 2010, the Legislature took the program statewide to help stem Medicaid costs.
Initially, patients could opt out of managed care in favor of seeing dentists like Levitt, who use fee-for-service billing, but that ends today.
Under managed care, the state pays each insurer a set amount for each child, an incentive to limit spending. Families owe nothing, but must see only dentists in their plan's network, a tough task.
Only about 15 percent of dentists participated in Medicaid in 2010. Even after the Legislature raised payment rates three years ago, they cover only about 40 percent of charges, said Dr. Robert Payne, a Marianna dentist who is the Florida Dental Association's representative on a state Medicaid advisory committee.
The two managed care companies have recruited around 2,700 providers into their networks, more than the 2,000 in the old fee-for-service system, according to Coleman, the Agency for Health Care Administration spokeswoman.
But Hays and other dentists say they've heard that dentists listed in the networks don't actually participate. Payne said he was listed on the DentaQuest plan but isn't a member.
Dr. Sandy Worman, a St. Petersburg pediatric dentist, said many dentists who take Medicaid do so only for short periods.
"So they're going to say, we have Dr. Smith and he's happy to see you," she said. "But if you look, I bet you they're not here more than 12 hours a week."
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Some dentists say the managed care companies delay care by requiring prior authorization — no treatment without the insurer's permission.
"You can't imagine the logistics of that," said Worman, who is dropping out of Medicaid. "Half the time the patients come in in pain, and you have to send them home."
Lacasa said greater care must be taken with public money. For instance, he said many dentists want to remove all the wisdom teeth when one is infected. "Pulling a healthy molar is not medically necessary," he said, "and the Florida taxpayer isn't willing to pay for that."
Suncoast Community Health Centers in Hillsborough, which treats a high percentage of poor patients, participates in both managed plans, said dental director Dr. H. Randolph Valdez. He has already had problems with prior authorization and billing delays, and worries the new setup won't do enough to help the children he sees suffering from "bombed out teeth."
Dental decay "is the No. 1 childhood disease in the nation," he said. "The sad part is that it's preventable."