Minnesota has been warned that its main government health insurance program risks losing federal funding if it doesn't provide more preventive dental care to children.
The problem is familiar to many families on Medical Assistance: Many dentists don't accept new patients covered by the program because Minnesota pays some of the lowest dental reimbursement rates in the country.
Just 37 percent of children on Medical Assistance in MInnesota got preventive dental care in 2015, and 62 percent of the participants reported having been told that a dentist was not taking new patients covered by the program. Nationally, 46 percent of children on Medicaid got preventative dental care, according to the Centers for Medicare and Medicaid (CMS).
Noting that such figures could place Minnesota out of compliance with federal rules, CMS regulators informed Minnesota officials that they must devise an improvement plan within 90 days.
"CMS has us on notice saying we have to take some kind of action," said Nathan Moracco, assistant commissioner for health at the Minnesota Department of Human Services, which runs Medical Assistance, Minnesota's version of Medicaid.
Gov. Mark Dayton's budget submission for the coming biennium proposed a 54 percent increase in dental reimbursement rates, but the nature of any solution hinges on what happens at the Legislature, where a conference committee is working on a compromise between health and human services funding bills from both chambers.
The Senate bill contains a 25 percent rate increase, while the House has no new money for dental reimbursement.
"It doesn't look too good," said Carmelo Cinqueonce, executive director of the Minnesota Dental Association, which supports Dayton's plan.
"At the bottom of this issue is ultimately appropriate funding for a program that has been woefully underfunded for far too long." Under current state payment rates, dentists get about 25 percent of their typical fees.
At Northern Dental Access Center in Bemidji, a nonprofit provider that serves 20 counties in northwestern Minnesota, about 62 percent of the 5,000 children they see annually have tooth decay.
"Access is a big problem in Minnesota and especially up here," said Executive Director Jeanne Edevold Larson. With 200 new patients each month, the clinic has to triage appointments to take care of those with the greatest need.
Access is not the only problem, Larson said. Many of the center's patients have complex needs, such as transportation problems and chronic medical conditions.
Federal officials have raised concerns about the issue before, but this is the first time they have warned that Minnesota could be out of compliance with federal regulations.
"The federal government is sending a clear message that they want to see dollars directed to providers," said Moracco.
It's not clear what CMS will do if Minnesota does not deliver on a plan, but the federal government has leverage because it provides a large share of funding for Medical Assistance.
"Certainly it can be up to and including the withdrawal of federal funds," Moracco said.