RI Medicaid to Address Rural and Urban Children's Oral Health Needs
Lack of access to oral health care is recognized as one of the biggest health dilemmas facing rural Americans today. A study from the National Rural Health Association found that rural adults are significantly more likely than non-rural adults to have untreated dental decay, and rural residents are less likely than their urban counterparts to have dental insurance. Factors that contribute to the problems of rural oral health include geographic isolation, lack of adequate transportation, lower dental insurance rates, and difficulty finding providers willing to treat Medicaid patients.
Dental care has been identified as one of the most unmet health care services need for Rhode Island (RI) children on Medicaid. Private dentist participation in Medicaid in RI has also been historically low, with only 51% of practicing dentists submitting claims to Medicaid in the past two years. Low Medicaid reimbursement rates play a critical role in the low participation rates. Medicaid rates are estimated to be 41% of the commercial payment rate to RI dentists; these rates have remained unchanged for 12 years.
Rhode Island is addressing some of these issues for the Medicaid population in a new statewide dental program called RIte Smiles. RIte Smiles is being launched on September 1st. RIte Smiles will help improve access to preventative and primary dental care. It is estimated that approximately 30,000 young children will be eligible to be enrolled in RIte Smiles.
Under this new delivery system, the State will contract with UnitedHealthcare Dental on a pre-paid, capitated basis to provide a managed care model for dental care. Currently, Rhode Island Medicaid covers dental services under a fee-for-service system. RIte Smiles' reimbursement rates will be closer to commercial rates. UnitedHealthcare Dental must establish and maintain a network of participating dentists, pay claims to dentists, and arrange interpreter and transportation services to members if needed.
Current funding only allows for children under age six to be enrolled in RIte Smiles. Children will age into the program, thus continuing their participation as they get older. Children currently older than six years old will not be enrolled in RIte Smiles, but will continue to receive their dental benefits under the fee-for-service Medicaid system.
For more information on the RIte Smiles program, see www.dhs.ri.gov under dental services or call the DHS InfoLine at (401) 462-5300.