State Sen. Anitere Flores, left, and state Rep. Jose Felix Diaz are Republican lawmakers from Miami.
The Florida Association of Health Plans, which represents health maintenance organizations, is pulling a bait-and-switch on the health of Florida's most vulnerable children. They oppose important legislation designed to protect the oral health of underserved kids.
At issue is roughly $200 million a year in taxpayer dollars for improved care to kids through the statewide prepaid dental health program.
As Florida's mandatory statewide Medicaid managed care system goes live, HMOs would rather these dollars flow through them. With the dental community's support, SB 340 and HB 27 will keep the successful prepaid dental health program alive.
Just a few months ago, the Agency for Health Care Administration said prepaid dental plans had increased the number of children receiving dental care and the number of dentists participating in the program. But the health plans association only talks about the achievements of one HMO whose dental program had positive results in one year. Medicaid reform HMOs have been operating for seven years, and for all but one plan in one year, prepaid dental plans demonstrated substantially better results.
Two national prepaid dental plans operate successfully in 62 Florida counties without HMO involvement. The HMOs contracted by the state to administer Medicaid benefits in five counties subcontract with these same two dental plans to provide dental care to kids, but rather than allowing the maximum dollars to flow to children, HMOs take a middleman's cut. Now, health plan association members want to take a cut of all dental dollars statewide. We are not sure how anyone can suggest this is a good thing.
Children's dental care is not an optional benefit under the new statewide managed care Medicaid system. It is mandatory. As the new system rolls out this year, HMOs want the children's dental business because they can subsidize their "free" adult dental benefits — and other services — with the profits realized by keeping utilization low among children.
The health plans association claims that health plans are going to provide adult dental services for "free." But it also says if children's dental money is held harmless and kept separate, $100 million in value for adult care would be lost. The two statements are not compatible.
Health plans will have no obligation to encourage dental exams for children or adults. The fewer people who seek dental care, the more money HMOs will have to pad their bottom lines. But dental care is the only thing prepaid dental plans do.
If the health plans association has its way, HMOs will continue to subcontract with prepaid plans, taking substantial middleman's cut, or will cut provider networks and dentists' pay to the point that utilization among children will fall back to being dead last in the nation. This is great if you own stock in an HMO, but not so great if you are a child.
The health plans association claims that by preserving the independent prepaid dental plan, Medicaid managed care contracts will need to be redone. But the AHCA had the foresight to build flexibility into its contracts, specifically allowing for benefit modifications at any time — particularly if state law is changed. That is standard practice.
With the dental community's support, SB 340 and HB 27 will keep the successful prepaid dental health program alive. We firmly believe the Medicaid HMOs will not cancel their health plan contracts with Florida over the precious dollars that would remain separate for children's dental care.
It is bad public policy to allow health plans to take $200 million out of the mouths of children to pay for a couple of adult cleanings and use the rest for whatever they please.
The prepaid dental program is working for Florida's children. Let's not allow the HMOs' flawed ploy threaten the health of our children again.