Understanding the Connecticut Dental Medicaid Reform Proposal: State Options in Contracting Dental Care in Medicaid

In today’s ever-evolving health care marketplace, states have multiple options for arranging dental services in their Medicaid programs.

For example, states may:

• Administer dental Medicaid programs directly or contract them through medical or dental managed care organizations;
• Retain administrative responsibility or not and opt to pass financial risk onto outside vendors;
• Include dental services in medical managed care contracting or carve-out dental services for separate management; or
• Contract with a single vendor or with multiple vendors for all or part of their enrolled populations or geographic areas.

In fact, options are limited only by the creativity of Medicaid officials, the receptivity of the marketplace, and, in some cases, the approval of federal authorities. Indeed, in their efforts to secure dental care for beneficiaries, states have experimented with various combinations of
these options.

Regardless of the options selected, states must currently meet – or obtain federal waivers not to meet – requirements that include a guarantee of access to needed dental services for covered children. As an observation of states’ efforts reveals, ultimately, only three factors relate to a state’s capacity to obtain dental care for beneficiaries:

1. Market-based payment rates to dental providers,
2. Engagement of sufficient numbers of providers, and
3. Effective program oversight.

The Connecticut Health Foundation (CHF), the state’s largest private, independent foundation dedicated to improving the health status of all Connecticut residents, has prepared this policy brief to:

• Describe the various program options and related decisions facing states as they determine how to obtain dental care for their beneficiaries,
• Present arguments (pro and con) for each decision, and
• Comment on the lessons to be derived from various states’ efforts.