Dunleavy's failure to plan creates Medicaid dental coverage chaos

After vetoing adult dental coverage for Medicaid recipients in June and again in August—rejecting the near universal testimony from health care experts—Gov. Mike Dunleavy has now signed off on a plan to resurrect coverage in January.

While the program is two-thirds funded by the federal government, the Dunleavy administration claimed that it was worthwhile to surrender $19 million in federal payments for dental services, so that it could “save” $8 million in state funds.

The governor, his staff and the GOP minority refused to listen to those who said the $8 million was an illusion, as the end of preventative care would lead to more dental emergencies and expensive trips to hospital emergency rooms paid for by Medicaid. The change would also make it more likely that Medicaid patients would develop other expensive health problems and lose their teeth, which would make it harder to find jobs.

At a March 19 hearing, Donna Steward, deputy commissioner of the health department, admitted under questioning that, “We have not done research as to what the results may be if individuals in Alaska Medicaid recipients do not receive dental care. We have not done any type of research on that.”

Rep. Ivy Spohnholz said it was a situation in which the state might save a little bit in one year, but have to spend much more in the years ahead.

State officials knew that federal approval would be needed to end the dental program, but no one figured that federal approval would not be forthcoming.

It turns out there won’t be any savings.

On Friday, a press release from Adam Crum, health commissioner, said that “most of the dental services included in the program were obligated to continue under federal law,” so the state has resurrected the program and will retroactively cover services for the months in which it didn’t exist.

That he didn’t know this before the first or the second time the program was vetoed is inexcusable.

The press release mentions “complex rules and federal requirements” as reasons for the reversal. The complexity claim is similar to the excuse made by the Dunleavy administration about its screwup with the Adult Public Assistance program.

Complexity comes with the territory. Crum, 35, whose main experience was with his family truck driving academy, told the Associated Press a year ago he was not a “health care policy guy.” His family donated to the Dunleavy campaign and the governor picked him to run the most complex department in the state.

Why did Crum or no one on his staff realize that most of the dental services had to be continued under federal law, so that federal approval would not happen? No answers.

In August, after Dunleavy vetoed the program for the second time, an exchange of letters between the Alaska Primary Care Association and Crum illustrated another element in the unrecognized complexity of cutting the dental benefit.

In her Aug. 29 letter, Nancy Merriman, executive director of the primary care group, summarized an Aug. 21 conference call with various private and state health officials. A verbal commitment was made by the state for continued dental coverage at the 27 clinics in Alaska that are federally qualified health centers. The health centers, patients and providers had already been notified that dental coverage would continue. This was in keeping with federal law.

“Despite the elimination of the Medicaid Adult Dental program, FQHCs may continue to offer all  FQHC dental services and be reimbursed by the Alaska Medicaid Program,” as required by federal rules, Merriman wrote, making sure everyone understood. She wrote that the health department had promised to write a letter clarifying all of this to the health centers, patients and dentists.

But the next day, Crum replied that, “We do not agree that Alaska will cover all enhanced adult dental services as they currently exist on and after Oct. 1, 2019.”

He didn’t say what services would be covered at the federally qualified health centers. I wrote at the time that the failure to deal with that simple question was in keeping with the continual bungling that marked the operation of Medicaid during his time as commissioner. It all stems from the governor’s effort to cut Medicaid spending without bothering to plan.

Fast forward to Friday and the press release announcing that the program would return: “Also under federal law, preventive dental care services must be covered by Medicaid when provided at federally qualified health centers that offer preventative dental care.”

This contradicts what he wrote on Aug. 30.

The recall petition against Gov. Mike Dunleavy says he “acted incompetently when he mistakenly vetoed approximately $18 million more than he told the legislature in official communications he intended to strike. Uncorrected, the error would cause the state to lose over $40 million in additional federal Medicaid funds.”

Everything about the handling of this program since early this year reflects mismanagement and an astonishing degree of incompetence.