By Anne Blythe
Key takeaways:
- Two paragraphs in NC’s new budget have oral health advocates scratching their heads in confusion about their practical implications.
- The provision does not eliminate Medicaid coverage for oral health surgeries, according to Mark Casey, dental director for Medicaid at the state Department of Health and Human Services, but he’s still trying to clarify some of the wording.
- The confusion highlights a broader pattern in North Carolina’s budget process, where significant policy changes get embedded in dense budget language that’s crafted with little public or committee input.
People who pay close attention to the machinations of state budget-making these days in North Carolina know that you can’t just look at the bottom line to understand how lawmakers’ spending choices will shape communities, families and the health care they’ll have access to.
You have to become adept at reading between the budget lines to get the sweeping effect.
In this year’s budget, on Page 265, two paragraphs raised questions among people in the oral health arena who typically are very skilled at translating bureaucratese into plain language and explaining the impact it will have in real life.
The paragraphs refer back to the 2023 budget and a section that adjusts Medicaid reimbursement for dental procedures performed in ambulatory centers.
WHAT THE BUDGET SAYS:
DURATION OF MEDICAID PROGRAM MODIFICATIONS
SECTION 9E.3.(a) Except for statutory changes or where otherwise specified, the Department of Health and Human Services shall not be required to maintain, after June 30, 2027, any modifications to the Medicaid program required by this Subpart.
SECTION 9E.3.(b) Consistent with the duration of Medicaid program modifications established in subsection (a) of this section, the Department of Health and Human Services shall not be required to maintain, after June 30, 2027, any modifications to the Medicaid program required by Section 15 of S.L. 2023-129.
The language in the budget approved by lawmakers on July 2 and signed into law by the governor on July 7 seems to sunset those modifications on July 1, 2027.
“The mystery is why this is being sunsetted,” said Crystal Adams, executive director at the North Carolina Oral Health Collaborative.
That’s one thing that Mark Casey, the dental director for Medicaid at the state Department of Health and Human Services, is still trying to get clarified.
But on Thursday, he was able to tamp down some speculation that the two paragraphs would eliminate access to some oral health surgeries for Medicaid recipients.
“Stakeholders are concerned because they don’t understand what surgical services that ambulatory centers provide,” Casey told NC Health News during a video interview. “I think the language in the legislation sort of misled folks.”
That code is used to pay ambulatory surgical centers for the supporting services that they provide to dental patients and their oral health practitioners during a procedure at their facility.
In those cases, there are three types of claims that can be filed with Medicaid services. One is for anesthesia provided by a professional at the surgical centers. Another is from a pediatric dentist or oral surgeon treating a child or adult at the center.
And lastly, the surgical center can bill for pre-op or post-op services and equipment provided to patients.
Before January 2024, Casey said, the Centers for Medicare and Medicaid Services did not use the same standardized point system that it uses for most medical practices and procedures for dental care.
Medicare does not cover many dental services for adults, he said, so the federal agency was using a different rate system. Medicaid in North Carolina, however, offers a broad array of dental services for children and others who benefit from the government subsidized health care. Because the state’s Medicaid reimbursement rate for dentists hasn’t changed since 2008, many dentists don’t accept Medicaid patients.
Nearly three-fourths of the Medicaid claims that come in from ambulatory surgical centers are for pediatric care, Casey said. A significant number are preschool children who can’t cooperate for treatment in an office, so they’re taken to an ambulatory center.
It could be a child needs a tooth pulled or maybe doesn’t understand how to sit for X-rays, Casey added, and needs the extra services such as anesthesia that can be provided in an OR.
The Medicaid billing codes were changed in 2024, Casey said.
Language matters
Like others well-versed in oral health billing practices, Casey said he still hasn’t figured out whether the budget language ends that practice starting next fiscal year.
“I don’t understand the sunset issue, so I need to get more guidance from our leadership or the people that give us guidance regarding the budget bills and other legislation,” Casey said Thursday.
Many state government insiders and political buffs have gotten used to seeing significant policy changes embedded in the financial document that in recent years has often been crafted behind closed doors by key players in the Republican-led state Senate and House of Representatives.
Because of how the budget bill was developed, there wasn’t much committee or public input on the fiscal map for the coming year. Had there been, advocates say, some of the confusion about the impact might have been addressed before the budget became law.
So as oral health advocates started sorting through the fine points of the budget, some questioned whether the intention of those two paragraphs was to curb surgeries that Medicaid would cover.
“I don’t think it bans surgeries, but I would agree that the language is not that helpful,” Casey said.
The post Oral health advocates try to unravel mystery of two NC budget paragraphs appeared first on North Carolina Health News.
