After a hint from her own dentist, Sheila Hagar started looking into concerns about the rising numbers of Medicaid kids getting braces in Washington. Hagar, who is medical and social services reporter for the Union-Bulletin, in Walla Walla, sought sources and found statistics that made her jaw drop.
“We should be taking care of people who really have a need,” a frustrated Walla Walla orthodontist, Thomas Utt, D.D.S., told her. “While his office – Walla Walla Orthodontics – is authorized to treat Medicaid-eligible children with braces,” Hagar wrote, “Utt grits his teeth at what he sees as misuse of funds and a lack of clarity over just what ‘medically necessary’ means when it comes to correcting kids’ teeth.”
Here, Hagar tells us more about how she tackled the reporting that led to her July 5 package “State Foots Skyrocketing $27 Million Bill for Braces” and what she is learning about orthodontic benefits under Medicaid. She also shares some wisdom on what to do when no one is returning your calls on an uncomfortable subject. Read how she did her reporting.
Dual eligibles are low-income elderly or disabled people enrolled in both Medicare and Medicaid. The distinctions are sometimes bewildering. It’s easy to confuse which program pays for what, what each agency considers “appropriate” care, what factors go into measuring outcomes and how the separate structures of Medicare and Medicaid affect costs and quality.
According to the Congressional Budget Office, in 2009, the federal and state governments spent more than $250 billion, combined, on health care benefits for the 9 million dual eligibles. There is growing concern about the high costs of dual eligibles and the type of care they receive. They may be treated by a variety of health care providers who are not coordinating their care, potentially increasing costs and worsening outcomes.
Many states are already struggling to meet current Medicaid demand, and as boomers age, more stress will be placed on an already fragile system. Learn more about dual eligibles and what issues to look for in your state with this tip sheet.
Quite a few folks in Tennessee are upset right now with DentaQuest, the giant dental benefits company that took over the contract to provide oral health services to poor kids under the state’s Medicaid program earlier this year.
Two hundred black dentists are riled that they were cut from the provider network. The state dental association has withdrawn its support for DentaQuest’s contract. And some consumers (including a group home operator) are saying the company is making it harder for patients to get the care they need.
Meanwhile, company officials insist that no child with TennCare benefits has lost access to dental care under their watch. They defend their performance in Tennessee, saying that screenings have increased and that the state network of 864 providers – one for every 857 patients – exceeds nationally recommended standards.
What is going on? The Tennessean’s Tom Wilemon has been working to find out. His story last month offered a look at the situation.
In this Q&A, he gives an update and some additional insights into his reporting. He also shares some wisdom with others who might find themselves tackling a similar story.
Though a state investigation has failed to prove that any dental providers committed fraud, scandal still hovers over Texas’ Medicaid orthodontic program.
Now questions are being raised in Washington, where there has been a spike in the number of poor kids with braces. Medicaid orthodontic spending in the state jumped from $884,000 for braces for just 1,240 kids in 2007 to nearly $27 million for 21,369 children last year, Sheila Hagar reported in a July 5 package for the Union-Bulletin in Walla Walla, Wash.
What is going on? Hagar talked to a Walla Walla orthodontist, Thomas Utt, D.D.S., in her quest to find out. Utt has been worrying about the increase and has been raising concerns on the state level.
“We should be taking care of people who really have a need,” Utt told Hagar. But “need” appears to be a moving and subjective target in the state when it comes to braces, Hagar reported. Continue reading
A couple of stories have begun to trickle out from states about the impact of Medicaid expansion on hospitals.
This one from the Arizona Daily Star by Stephanie Innes, for instance, reports that uncompensated care dropped by a third in the first four months of 2014 from the prior year – a pretty significant number. The hospitals in that period wrote off $170 million in 2014, versus $246 million from Jan through April in 2013.
She uses data from the state’s hospital industry to report on uncompensated care (both bad debt and uncompensated care) and the hospitals’ bottom line.
“The Arizona hospital report shows the average operating margin of Arizona hospitals has gone up from 4 percent in 2013 to the current rate of 5.2 percent — a signal to some health experts that the Affordable Care Act will be a net positive for hospitals’ bottom lines,” she wrote. Continue reading
Every year, the Centers for Medicare & Medicaid issues a list of troubled nursing homes as part of its Special Focus Facility Initiative. CMS released an updated list on June 19 as a PDF and AHCJ has posted the list as a series of web pages and has made them available to download as Excel spreadsheets.
The initiative is intended to address nursing homes that cycle in and out of compliance. Homes in this program are visited by survey teams twice as frequently as other nursing homes. This list includes nursing homes added to the SFF initiative and updates the status of homes already in the program.
This year, 15 homes in 14 states were added to the list. Sixteen others were found to have “failed to show significant improvement,” 23 were deemed to have shown improvement, 33 have “graduated” from the program and four are no longer participating in Medicare/Medicaid.
Angelo Fichera of The Philadelphia Inquirer recently reported on one nursing home that will likely close after spending three years in the SFF Initiative, noting that CMS has not seen an improvement in care:
CMS expects that after two years on the watch list, nursing homes will either improve and “graduate” from the program; have funding terminated; or be granted an extension to improve because of “promising progress,” according to the agency.
To round out your reporting on nursing homes, AHCJ just updated its version of CMS’s Nursing Home Compare database, which includes details of the most severe deficiencies found during nursing home inspections for the past three years. AHCJ posted separate files covering the star ratings for nursing homes – from 1 to 5 – based on quality, inspection results, staffing and overall ratings.
The rumblings in Tennessee started earlier this year, after a new company took over the contract to provide dental services to the state’s children covered by Medicaid.
Now the state dental association, a number of black dentists, a youth-home operator and at least one angry grandmother are weighing in against the Boston-based dental benefits giant DentaQuest. They claim the company is making it harder for poor kids in the state to get dental care.
The Tennessean’s Tom Wilemon captured the mood in a June 6 story, “Complaints Mount about TennCare Dental Provider:” Continue reading
Image by Official U.S. Navy Page via flickr.
Reporter Katie Hiler decided to look into dental care for the poor in Missouri. The situation, she concluded in her reporting for KBIA Mid-Missouri Public Radio, might best be summed up by a quote from the film Argo: “There are only bad options. It’s about finding the best one.”
Nearly a decade ago, the state eliminated funding for all Medicaid beneficiaries except children, pregnant women and the disabled, she explained.
The move “left a lot of people with only bad options,” she says in a May 15 report.
“Many find themselves in the ER with tooth infections, where cost for treatment per patient can run on average around $9,000. Some try to find affordable care at Federally Qualified Health Centers where services are discounted for low-income patients, but aren’t free.” For the very poor, she added “the only option is charity dental care.” Continue reading
Texas Tribune health writer Becca Aaronson has been providing in-depth coverage of the state’s unfolding Medicaid orthodontic scandal.
The allegations of widespread fraud and abuse related to braces for poor children first came to light in the 2011 “Crooked Teeth” investigation aired by WFAA-Dallas.
The “Crooked Teeth” stories revealed that Texas was spending more on Medicaid orthodontic services than the nation’s nine other most populous states combined. The reports raised questions about whether dentists were providing unneeded braces to Medicaid children and sending the program the bill.
Three years later, a state investigation has failed to prove that any dental providers committed fraud.
I keep waiting for the final official HHS report on enrollment and the state and demographic breakdowns, but since we don’t yet have it (Charles Gaba reports it should come out at 2:15 p.m. today) – let’s just recap what we do and don’t know about enrollment as of the end of April. To find out more, talk to your state insurance commissioner, exchange officials, the Medicaid office, brokers and the major insurers.
Just over 8 million in exchanges: This is the sign-up number – as critics of the law keep reminding us, not everyone has paid, or will pay. AHIP’s Karen Ignagni told me the expected rate is about 85 percent payment, 15 percent nonpayment (and no, young people are not failing to pay at way higher rates based on what we know so far). If that 15 percent figure is right, enrollment is still about 6.8 million.
Plus people will continue to go in and out of the exchanges. If you have a baby, get married or divorced, turn 65 (leaving exchange for Medicare), turn 26 (leave mom/dad’s plan for the exchange) change jobs etc etc, you can still enroll (or unenroll). The number will be in flux. There will probably be a net rise but no one is sure because it’s a new landscape.