Dental Public Health Activities: Descriptive Summaries
Medicaid Travel of Pediatric Dental Teams- Archived Summary
Residents in many communities in Alaska often rely on air or marine transportation to access healthcare, including dental services. In remote locations of Alaska, residents often receive itinerant dental visits with dentists flying, boating or snowmobiling into small communities to deliver dental care – or individuals travel to regional hub communities to access dental care. Like many states, access to dental services for children enrolled in Medicaid, especially new Medicaid clients, is a long-standing problem. To meet dental treatment needs, especially urgent treatment needs, it is not unusual to use air travel of the child and accompanying adult to a hub community or urban community for dental care. The Alaska Medicaid State Plan stipulates that provider travel expenses and per diem may be paid when State Public Health Nurses request this as a means to provide access to services. This was found to be necessary as a result of dental treatment needs found in delivery of EPSDT screening services in several regions within Alaska.
In FY2001, the Alaska Division of Public Health initiated a grant with the Southeast Alaska Regional Health Consortium (SEARHC), a non-profit Native health corporation, to assist with travel and per diem costs for pediatric dental teams traveling in southeast Alaska to deliver services as a result of limited Medicaid dental access in a number of communities within the region. The teams provide dental examinations and treatment for children, including non-Native children, enrolled in the Denali KidCare/Medicaid program (Medicaid and CHIP). During the first year of the grant (November 2000 - June 30, 2001), the project provided 1,649 dental visits to more than 900 children enrolled in Medicaid. Medicaid covered all travel related expenses for the project during the first fiscal year; however in SFY2002-SFY2003 the grant funds only covered about half of the total travel-related expenses with SEARHC covering the balance of these expenses. In SFY2002 605 children enrolled in Medicaid were seen (2,162 Medicaid patient visits in SFY2003). In SFY2004, the project was included in a Medicaid contract (EPSDT continuing care agreement). Currently, the transportation costs are part of the cost settlements as part of the change to a cost-based reimbursement methodology for the Tribal dental programs. The project has been a good collaboration between SEARHC and the department in expanding access to dental services for children enrolled in Medicaid.
A second project was implemented with an Anchorage private pediatric dentist in April 2001 to provide Medicaid pediatric dental services in the Kenai Peninsula region of the state – another region with longstanding limitations on Medicaid dental access. This Medicaid contract has continued through SFY2012 and has reduced the need for transportation, often air transportation, for children and their parent/caregiver to Anchorage to obtain dental services. Between SFY2007-SFY2011 the pediatric Medicaid dental visits under this contract averaged 1,080 visits per year. Air fare from communities in this region to Anchorage would be in excess of $500/child (assuming transportation for the child and accompanying adult.)
Medicaid reimbursement of provider travel can assist with access to dental care (pediatric specialty dental care in this case) and offers potential to reduce Medicaid transportation costs. Local provision of services is more convenient for families and for school-aged children reduces time missed from school. The provisions for provider travel may be unique to the Alaska Medicaid State Plan given the reliance on air transportation in the state.
Contact Person(s) for Inquiries:
Bradley J. Whistler, DMD,