NEW SECTION. Sec. 1. Washington state currently provides dental coverage for enrollees in medicaid apple health coverage. Dental services have been successfully provided for children in part due to: Higher reimbursement rates for services provided to children and through a public-private partnership with the access to baby and child dentistry program that recruits and trains dentists to provide preventive care to medicaid children, reduced barriers for low-income families in accessing care with outreach, and enhanced reimbursement for services provided to children from birth through age five.

Adults in medicaid apple health have more difficulty accessing dental care. As a statewide average, only twenty-two percent of apple health adults utilized care in fiscal year 2015. Utilization rates vary across the state, ranging from 7.6 percent to 31.4 percent.

A growing body of research indicates oral health is connected to systemic health. Pregnant women are more susceptible to oral health problems due to changes in their bodies related to pregnancy. Dental disease may cause complications during pregnancy, such as preeclampsia and gestational diabetes. Adults with diabetes are also at high risk for oral health problems. The chronic inflammation and infection associated with gum disease can result in serious health complications, including heart disease, kidney disease, blindness, and amputation.

Studies have found significant medical savings when patients with chronic conditions like diabetes and pregnant women received treatment for gum disease. The legislature therefore finds that the state should invest in a pilot program to test enhanced dental benefits for medicaid apple health adults with diabetes and pregnant women.

(1) Subject to the availability of amounts appropriated for this specific purpose, the health care authority must begin a three-year pilot program, named oral health connections, with the Washington dental service foundation, modeled after the access to baby and child dentistry program, to test enhanced dental benefits for medicaid apple health adults with diabetes and pregnant women. The pilot program's aim is to better integrate medical and oral health care to improve health outcomes and control chronic disease. The pilot program must include enhanced reimbursement rates for participating dental providers and an increase in the allowable number of periodontal treatments to up to four per calendar year. The Washington dental service foundation shall partner with the agency and provide wraparound services to link patients to care. Services include, but are not limited to, outreach to and support for medical providers, dental providers, care coordinators, accountable communities of health, managed care organizations, and eligible medicaid enrollees, in order to connect people with diabetes and pregnant women with the oral health care they need.

(2) The health care authority and Washington dental service foundation shall jointly determine the counties or regions to participate in the pilot program, subject to the availability of amounts appropriated for this specific purpose. The authority and foundation shall provide joint progress reports to the appropriate committees of the legislature each December 1st commencing after implementation of the first year of the pilot program.


State of Washington	65th Legislature	2017 Regular Session