Delta Dental the state's choice to offer Medicaid benefit
Nov. 1—Delta Dental Plan of New Hampshire is the firm recommended for a $34 million contract to deliver the first-ever dental benefit for 88,000 adults on Medicaid.
If approved, the contract with a two-year extension could run through March 2026. The Executive Council will consider the nearly-400 page contract at its meeting today .
Gov. Chris Sununu and legislative leaders from both parties reached consensus last spring on dental benefits for Medicaid recipients, an issue that advocates had been working on for two decades.
Medicaid is the federal-state health insurance program for the poor, disabled and some senior citizens.
House Republican leaders dropped their long reluctance to the dental benefit once they had found a handy revenue source for the first three years. In January, Centene Corp., one of the three firms providing managed care for New Hampshire Medicaid clients, agreed to pay $21 million to resolve the state's inquiry into whether the company was overcharging for prescription drugs.
The new law claims all of that settlement money as the state's 28% match to about $45 million in federal grants over those three years.
The contract is the first major step of a process that will offer the benefit starting April 1. The state Department of Health and Human Services is asking the Biden administration for a waiver so it can require adults on Medicaid to make a co-pay, which will apply to adults with incomes above the federal poverty level.
Preventive dental care will be exempt from any co-pay.
The co-pay for each non-preventive service would be equal to 10% of the cost provided it's less than 5% of the person's annual income.
State Rep. Jess Edwards, R-Auburn, said adults on Medicaid were more likely to receive good dental care if they had "skin in the game."
Until this change, the only Medicaid dental coverage for adults was for extraction of infected teeth.
Under the new program, Medicaid will cover annual comprehensive oral examinations, X-rays, treatment to prevent disease, topical fluoride, oral hygiene instruction, behavior management and smoking cessation counseling.
The contract places an annual cap for coverage of $1,500, though that does not include preventive care expenses.
The plan also will reimburse for replacement fillings along with oral surgery needed to relieve pain or eliminate infection.
The benefit would limit coverage for dentures to Medicaid clients with developmental disabilities, acquired brain disorders and those in the Choices for Independence program that supports seniors and other adults with chronic illnesses.
State Sen. Cindy Rosenwald, D-Nashua, the bill's prime author, said reimbursement rates have to be high enough to get dentists to accept Medicaid patients.
The contract includes one provision dentists had lobbied for, to cover their "care management" expenses so there aren't high numbers of patients who fail to show up or can't get transportation to an appointment.
A team of state officials gave Delta Dental a higher score than the other bidder, MCNA Health Care Holdings Inc., a managed care dental company that covers 5 million members in eight states.
