“Access to Care” Under Medicaid Means Time to Obtain Treatment, Not Distance to the Provider As Measured by State Third Party Administrator DentaQuest

BOSTON, MA, UNITED STATES, May 20, 2024 /EINPresswire.com/ -- The American Alliance for Dental Insurance Quality (AADIQ) has released on its website an important letter from the Massachusetts Dental Society (MDS) addressing critical "access to care" issues within the Massachusetts Medicaid system. The letter, backed by nine prominent dental organizations, highlights serious non-compliance by DentaQuest, MassHealth's third-party administrator, with federal access to care requirements for Medicaid children.

The letter, spearheaded by Dr. Mouhab Rizkallah, President of AADIQ, and signed by leaders such as Dr. Abe Abdulwaheed, President of the Massachusetts Dental Society, Dr. Elon Joffre, President of the Massachusetts Association of Orthodontists, Dr. Derek Zurn, President of the Massachusetts Academy of Pediatric Dentistry, as well as Dr. Rizkallah, outlines significant flaws in DentaQuest's network adequacy analysis.

Dr. Rizkallah emphasized, "When complied with, children's Medicaid is the finest insurance program in the world. Sadly, DentaQuest mishandles many provisions of the Medicaid Act, exposing programs such as the Massachusetts Medicaid agency to federal law violations. The result is that poor kids struggle to find dental care. There is no excuse for this legal noncompliance, and this is consistent with many other patient-harming behaviors we have found DentaQuest responsible for."

The letter emphasizes that DentaQuest uses a distance-to-provider metric instead of the federally mandated "'care and services availability'" metric. This incorrect approach results in inadequate network adequacy.

DentaQuest's current metric defines access as being 10 minutes to a general dentist and 30 minutes to a specialist. However, federal statute 42 USC-1396a(30)(A) requires state programs to ensure payments are sufficient to enlist enough providers so that care and services are available under the plan to the same extent as they are available to the general population.

"Minutes to provider is an evasive and meaningless metric," emphasized Dr. Rizkallah. "All state programs must use 'care and services availability' to comply with federal law. That means every state must determine how much time it takes for a child to get the needed treatment, not just get to the front door of a provider who has no time to treat the child."

The MDS letter also notes that it is insufficient to only determine "care and services" availability from MassHealth providers. MassHealth must also compare this availability with that of the general population (non-MassHealth providers) to ensure compliance with federal law. This comparison is critical in setting appropriate payment rates.

Dr. Rizkallah pointed out that noncompliance with 42 USC-1396a(30)(A) is not trivial. It jeopardizes the state's receipt of over $10 billion in federal funds annually and denies poor children their Medicaid entitlement. "The words 'at least' are a powerful choice of words. Legislators clearly wanted poor children, who have higher social determinants of health risk, to have even more access than others," he said.

The noncompliance letter, sent on February 9, 2024, concludes with a request for MassHealth to implement a secret shopper comparison of Medicaid provider availability against non-Medicaid providers, followed by a Medicaid rate increase to comply with federal mandates. No response to the letter has yet been received.

PDF Copies of the letter and attachments can be downloaded from the AADIQ website.


About the American Alliance for Dental Insurance Quality
The American Alliance for Dental Insurance Quality (AADIQ) originated as the “Committee on Dental Insurance Quality,” which was founded to ensure passage of Massachusetts Question 2 (2022) – the first dental voter ballot in history. The AADIQ is dedicated to improving the quality of private insurance and Medicaid insurance plans in every state.

The Board of Directors:
Dr. Mouhab Rizkallah DDS, President. Dr. Rizkallah is a distinguished orthodontist who was honored as Dentistry Today’s “Person of the Year” in 2022.
Dr. Margaret Scarlett DDS, Vice President. Dr. Scarlett is a renowned dentist, author, and pandemic disease expert.
Dr. David Leader​​ DDS, Treasurer. Dr. Leader is the director of the Tufts University School of Dental Medicine DMD/MPH Dual Degree Program.
Dr. Patricia Brown DDS​, Director. Dr. Brown is a Past President of the American Academy of Dental Sciences.
Dr. Andrew Chase DDS, Director. Dr. Chase is a Past President of the Massachusetts Association of Orthodontists.

Dr. Mouhab Rizkallah
American Alliance for Dental Insurance Quality
info@dentalinsurancequality.org