The experience of Dr. Marty Killeen, a pediatric dentist in Lincoln, provides a troubling warning about the problems facing Nebraska’s Medicaid program covering dental work for low-income children. Killeen worked for 13 years with the Lancaster County Health Department but has left the department and ended his Medicaid service after an audit placed unusually heavy financial burdens on him.
The audit penalties exceeded Killeen’s costs of dental school, he testified at a legislative hearing last week.
A variety of Nebraska dental representatives addressed the lawmakers, rightly saying the audit process needs an overhaul in order to stem a decline in the number of pediatric dentists participating in the Medicaid program.
Members of the Health and Human Services Committee were understandably struck that the audit of Killeen failed to follow a 2015 Nebraska law in key regards. That law requires that audits go back no more than two years; the audit of Killeen involved cases beyond two years.
The 2015 law also mandates that the audit be performed by a dental professional; the first phase of Killeen’s audit was conducted by a nurse.
The hearing demonstrated how the auditors’ insistence on using fillings conflicts with the dental profession’s standard, which says bridges are the best long-term solution for low-income children, who often are in health crisis mode by the time they see a Medicaid-funded dentist.
The auditor’s approach puts dentists “in an impossible situation,” the lawmakers were told.
These professional standards are “the well-advised and evidence-based guidelines” that practitioners consider “the bible of pediatric dentistry,” Killeen said.
The University of Nebraska Medical Center teaches its dental students to use those standards, and if “we are asked to disregard those, as an educator I wouldn’t know what to teach,” Dr. Jillian Wallen, an associate professor at UNMC, testified.
Long term, it’s “far more expensive to undertreat” a child, Dr. Jessica Meeske, another pediatric dentist, told the committee. Dentists choose the treatment that is the most cost-effective for the long term, she said.
Oversight of Medicaid spending is justified, but the excessive penalties imposed on dentists are not.
Nebraska lawmakers need to develop a new statute, and promote dialogue between regulators and dentists, to address problems identified at the hearing.