SENATE BILL REPORT

SB 5540

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Background: The Washington State Health Care Authority (HCA) currently provides dental coverage for Medicaid enrollees as a fee-for-service program. The dental coverage for adults was removed in 2011 and restored in 2014 in the state budget, but the dental reimbursement rates have not been updated recently. Approximately 22 percent of adults utilized dental services in fiscal year 2015.

Approximately 56 percent of children utilized dental services in fiscal year 2015, in part due to the success of the Access to Baby and Child Dentistry (ABCD) Program, which is focused on children from birth to age six. The ABCD Program is a collaborative effort with the Washington Dental Service Foundation, the University of Washington School of Dentistry, the Department of Health, and others. The ABCD program works closely with a local dental champion to recruit and train dentists to participate in the program, and offer enhanced reimbursement for providers. Additional efforts are focused on provided outreach and education to families with eligible children.

Research shows oral health is connected to systemic health. Pregnant women are more susceptible to oral health problems and dental disease may cause complications during pregnancy such as pre-eclampsia and gestational diabetes. Adults with diabetes are also at high risk of oral health problems. Studies of commercially insured populations have demonstrated significant medical savings when patients with chronic conditions like diabetes and pregnancy received treatment for gum disease.

Summary of Bill: Subject to appropriation, HCA must begin a three-year pilot program (program), named Oral Health Connections, with the Washington Dental Service Foundation (Foundation). The program must be modeled after the ABCD program and it must test enhanced dental benefits for Medicaid Apple Health adults with diabetes and pregnant women. The program's goal is to better integrate medical and oral health care to improve health outcomes and control chronic disease. The program must include enhanced reimbursement rates for participating dental providers.

The Foundation must partner with HCA and provide wraparound services that may include outreach to and support for medical providers, dental providers, care coordinators, accountable communities of health, managed care organizations, and Medicaid enrollees, in order to connect people with diabetes and pregnant women with oral health care.

The Foundation and HCA must jointly determine the counties or regions for the program, and jointly provide an annual progress report to the Legislature after implementation of the program. The program expires June 30, 2022.

Staff Summary of Public Testimony: PRO: When we target services and start services early there will be savings associated with high-risk individuals. We should start a pilot to demonstrate the potential savings. We are offering a funding partnership to test the expansion of dental services in improving health for these adults. Washington State is known nationally for improving dental health for children and this pilot builds on the learning and experience we have gained with the ABCD program. The Foundation is committed to participating financially and we are committed to the ABCD model. We believe there will be savings from this model. We have experience participating in the ABCD program and we know it works. The enhanced rates plus the care coordination and wrap-around services make this a success and we believe it can work for pregnant women and adults with diabetes.

OTHER: The clinics support expanding access to care, especially for pregnant women and patients with diabetes. We appreciate the Foundation's work to help expand access and dentist participation. The private sector providers are needed for the capacity. This bill does not address the change in the number of visits that will be required. Currently one per year is authorized but the medical standard of care is up to four visits per year. I believe there is an amendment to clarify. We would also like the additional visits to be available at the clinics, and to ensure the pilot does not disrupt the care the clinics provide.