HMO Dental System

The Legislative Audit Bureau’s June 2008 report on Wisconsin’s dental Medicaid HMO program provides proof that this system costs the state more money while providing less access to dental care than the MA fee-for-service model.

Despite this data, beginning Aug. 1, 2010 the state chose to keep the HMO component in the four counties of Milwaukee, Waukesha, Racine and Kenosha and to expand the program into Washington and Ozaukee counties.

Thankfully, expansion contracts for the six counties included a requirement that the medical HMOs must pay participating dentists at the MA fee-for-service rates or higher. In 2011 and early 2012, the WDA assisted HMO dental MA providers in obtaining back payments from the HMOs and the dental managed care organizations which had already failed to abide by their contractual obligation to pay for care at the fee-for-service rates.

Data indicates MA patients residing in the state’s HMO counties have lower access to dental care than those living in fee-for-service counties. This is a key reason why the WDA continues  advocating for the standard fee-for-service program to replace the HMO dental MA program in southeastern Wisconsin counties.

WDA