NMDA Journal Winter 2019

nmdental.org 19 Colorado added an innovative program for adults three years ago. In order to provide increased reimbursement rates and a broad range of services patients are given an an- nual maximum of $1,000. This limits some risk of overutilization and encourages personal responsibility. They are currently considering a plan to allow patients to earn increases to the maximum by making healthy choices and obtaining preventive care. The Colorado Den- tal Association partnered with the state to increase participation with a program called Take Five. Dentists receive a $1,000 bonus after seeing their first five new Medicaid pa- tients. They can receive an additional bonus after seeing 55 and again after 105. There has been a dramatic increase in participation and dentists are expressing a high degree of satis- faction with the program. New Mexico’s dental Medicaid program is desperate for some real reform. Since it has been almost 20 years without an increase in reimbursement levels, the state is going to have some catching up to do. An increased investment should be accompanied by substantial reforms in administration to find savings. Improving this program will impact nearly half of our citizens and should be done with careful consideration. There are suc- cessful ideas from several other states worth investigating and piloting here. Medicaid: Designed to Fail What's Wrong with Medicaid? IT IS DESIGNEDTO FAIL »» It is modeled after commercial dental benefits »» Rules are intended to limit utilization and mitigate risk »» In the Medicaid environment, there is no incentive for prevention and there is disincentive for definitive care »» The program discourages participation through poor reimbursement, unnecessary red tape, aggressive enforcement activities and uncertainty of getting paid. NM: 49.8% (37.5%) 16th »» Program requires robust cost-shifting, subsidy or selective practice model