The Legislative Audit Bureau released its report on April 18, 2008 that confirms the WDA's concerns that Medicaid patients enrolled in health maintenance organizations in Milwaukee, Waukesha, Racine and Kenosha counties have greater trouble accessing dental care than patients covered under a straight fee-for-service program in the other 68 counties of the state. 

The LAB reviewed dental care services provided under the state’s medical assistance program in the four southeastern counties during fiscal year 2006-07. Wisconsin spent an estimated $46 million to provide dental services statewide to MA recipients in 2006 with $12.3 million of those funds being paid directly to the HMOs in the four southeastern counties.

The LAB report notes despite those payments, HMOs failed to consistently maintain an adequate number of providers and timely access to patients. The HMO system resulted in lower utilization of care for MA enrollees, particularly children, and higher costs than what is provided under the fee-for-service model that delivers dental care in the other 68 counties of the state. The average cost per MA recipient receiving services under fee-for-service during the audit period was $211 compared to $270 under the HMO program.

This points to at least 25 percent, if not more, of HMO contracted fees being spent on system administration rather than on providing necessary dental care to MA recipients.

“This report confirms suspicions the WDA has held for more than a decade – namely the HMO delivery model for dental MA costs the state more money while providing less care to the patients who need it most,” says WDA President Dr. Monica Hebl. “It is wonderful to see our concerns confirmed by a reputable non-partisan entity like the LAB.”

The LAB also highlights an ever-growing MA population noting that in just the last five years, overall statewide enrollment has expanded by 15 percent with approximately 175,458 of the 750,000 MA patients residing in the four-county HMO region.

“This report focuses on the four counties, but it is clear the access to dental care problem is statewide due to growing numbers of MA enrollees and plummeting reimbursement rates. Despite donating millions of dollars of care annually through special outreach efforts and in their private dental practices, dentists simply cannot address this problem through charity care alone,” says Hebl.

• Read the LAB's official report
• WDA testimony before the Joint Legislative Audit Committee | June 10, 2008
• Letter to Audit Committee from Racine general dentist Dr. Lyndsay Knoell
• View presentation from the Joint Legislative Audit Committee's hearing on the HMO audit

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In the news

The Milwaukee Journal-Sentinel published an editorial on Tuesday, April 22, 2008 that says the HMO model of delivering dental care to MA patients in the four-county Milwaukee area isn't working and needs to be replaced.

Editorial: Junking the status quo
A new state audit confirms what some lawmakers and the Wisconsin Dental Association have been saying for years - a vast majority of lower-income children, especially in the Milwaukee metropolitan area, are not receiving proper dental care. 

• Read the rest here