According to our review of the annual third-party actuarial reports produced for Texas HHS Provider Finance, the Medicaid dental premium rate for dental maintenance organizations has dropped significantly since 2011. The proposed per-member, per-month capitation rate paid to the DMOs has gone from an actual experience rate of $36.53 in 2011 under fee-for-service to a proposed rate of $25.73 in 2024. This does not include orthodontic spending.
DMO fees
DMO fees to administer the program were $1.55 per member per month in 2013 and eventually increased to $1.75 per member per month. “This amount is intended to provide for all administrative-related services performed by the MCO,” according to the 2013 report.
Lacking CMS approval
It should be noted that CMS has not approved the rates proposed from 2021 to 2024. This could be due to the Public Health Emergency (PHE).
Just the figures
Information was taken from the various reports and placed in the following table. Our only calculation is to subtract the actual spending from the projected spending for each available year.
As we are not actuaries, we will only comment on the figures, not how they were calculated.
Roll out of managed care
Before managed care, dental billings under fee-for-service controlled by Xerox/Conduent were $1.2 billion in 2011. Managed care dropped this to $881 million in 2013, with member months dropping by close to 4 million or the equivalent of 333,000 Medicaid-eligible children (4 million/12 months/year).
Spending on dental climbed back to the $1 billion mark in 2015 and started down again before the pandemic.
COVID & PHE
Although spending did go up in 2022 due to the addition of 13 million member-months (33 million to 46 million) or the equivalent of just over 1 million children under 21, the cost per member-month went down significantly to $23.71 because so few members came for service during the pandemic due to shutdowns.
The 2022 report states, “COVID-19 and the resulting Public Health Emergency (PHE) has had a significant impact on the Dental programs. Medicaid enrollment has grown by over 25% while the average cost for all services declined at unprecedented levels. The enrollment growth is directly connected to the declaration of the PHE while the cost reductions are due to many factors including but not limited to; mandatory shutdowns, mask mandates, social distancing, and countless other environmental factors.”
Here is the information for your perusal.
