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Florida dental program draws concerns for people with disabilities

TALLAHASSEE, Fla. – As Florida wrestles with the future of services for people with intellectual and developmental disabilities, a top state official is warning that one program isn’t working for them.

Florida in 2018 placed people with disabilities into a dental program that is run by a handful of managed-care companies. But Agency for Health Care Administration Secretary Mary Mayhew said this week she’s “acutely concerned” that the program is not working as it should.

“Currently, Florida is not meeting the mark on access to dental care, and I am acutely concerned about appropriate access for individuals with intellectual and developmental disabilities,” Mayhew said in a statement. “I intend to hold plans accountable to meeting the necessary targets to ensure timely access to dental care within our Medicaid program.”

Florida established a freestanding dental managed-care program and entered five-year contracts in 2018 with three plans: DentaQuest, MCNA Dental and Liberty. People with intellectual and developmental disabilities, like all other Medicaid beneficiaries, were required to enroll in one of the plans.

The Agency for Health Care Administration prepares a monthly report tallying complaints about Florida’ overall Medicaid managed-care system. Dental care has been ranked in the top four or five categories of complaints for the past 11 months.

But the report does not indicate whether the complaints are stemming from people with disabilities or other groups, such as children or low-income seniors. Moreover, the report doesn’t indicate which health plans are involved in the complaints.

Mayhew said AHCA is “currently working to improve our complaint intake process at the agency. We take seriously the concerns and complaints expressed, and they are evaluated to inform any necessary changes to the system.”

Even without hard data from the state, advocates for people with disabilities say managed dental care has been less than ideal.

The Florida Developmental Disabilities Council surveyed its members this year to gauge views on Medicaid services. Florida currently serves about 34,000 people with intellectual and developmental disabilities, with about 21,800 more are on a waiting list.

Valerie Breen, executive director of the Florida Developmental Disabilities Council, said the survey results indicated wide discontent with the new managed dental program.

“It was a little surprising,” Breen said. “It was such a pervasive comment. It seemed to be a top issue for many.”

Dental care has also been a hot topic at the last several meetings of the Family Care Council of Florida. The statewide council was established in law to serve as an advisory committee to the Agency for Persons with Disabilities.

While no one likes having to switch health plans or providers, “I think with our population it’s often a little more critical,” said Dina Justice, vice chair of the Family Care Council of Florida.

Justice said that the council has pressed the state for information about the dental program but to no avail.

People with intellectual and developmental disabilities receive services through what is known as the iBudget program. That program is designed, in part, to help people live as independently as possible in their homes or in their communities.

Each person has an individual budget to spend on the services they require. A person’s budget is determined using a complex algorithm.

Unlike most other beneficiaries in Florida’s Medicaid system, people with intellectual and developmental disabilities are not required to enroll in managed-care plans for medical services. But they are required to get dental services through managed care.

The concerns about dental care come as the Legislature considers redesigning the iBudget program, which for years has cost more than what lawmakers had agreed to spend.

During the 2019 legislative session, lawmakers directed the Agency for Persons with Disabilities to work with AHCA, which runs much of the Medicaid system, to develop an alternative model for providing home- and community-based services.

The resulting report did not recommend broader use of managed care, but advocates for people with disabilities fear that is the direction the state is moving.

Senate President Bill Galvano told The News Service of Florida last week that properly funding the Agency for Persons with Disabilities and addressing the waiting list has “been a reality my entire career,” since he first worked on the issues while serving in the Florida House.

Galvano said the Senate is working on ideas about what can be done to hold down costs for people whose care can be better coordinated and to offer access to people on the waiting list.

“The challenge is, there are people who need services that aren’t getting anything,” Galvano said. “It’s escaped us for so long.”

But when asked, Galvano steered clear of saying managed care was the answer. He stressed there are some people whose care is so complex that it cannot be capped or overseen by a managed care company. The Bradenton Republican said he’d “rather have the status quo than people who need services not get them.”

Senate Health and Human Services Appropriations Chairman Sen. Aaron Bean, R-Fernandina Beach, said he expects to unveil a proposal by the middle of January. The 2020 session starts Jan. 14.

Similar to Galvano, Bean shied away from using the words “managed care.” He said managed-care plans were an “option” but not his focus.

“They do a great job for our Medicaid program. But I don’t know if they are a good fit here,” Bean said.

Bean said his plan is to preserve services for people already receiving assistance but to also work to get people off the waiting list.

“I know that if you’re receiving services, you’re scared there are going to be big changes,” Bean said. “And I know if you’re on a waiting list, you’re scared we aren’t going to make any changes.”