(The Center Square) — An audit conducted on one of Medicaid’s largest dental providers in Louisiana showed its spending and networking fell short of expectations.
The Louisiana Department of Health began contracting with DentaQuest and MCNA Insurance Company on January 1, 2021 to provide Medicaid members with covered dental benefits and services.
From 2014 through 2020, the state health department contracted solely with MCNA for dental services. However, the agency now contracts with two dental benefit programs because federal law requires that states give Medicaid members a choice of at least two programs.
The total cost of both contracts through Dec. 31, 2023, was approximately $736 million. The following year, the department sought and received approval from the Legislature for a two-year extension of MCNA’s contract through Dec. 31, 2025.
While the health department also sought a two-year extension for DentaQuest, the Legislature was less enthusiastic to continue business with them and only approved a one-year extension of DentaQuest’s contract through Dec. 31.
Lawmakers asked the the Louisiana Legislative Auditor’s Office to conduct a follow-up review of DentaQuest prior to extending its contract.
The department paid a little over $400 million to DentaQuest for dental coverage for around 1.2 million Medicaid members from January 1, 2021, through March 31. However, DentaQuest only provided $232.7 million in dental services over this same time period.
Because DentaQuest did not meet the contract requirement to spend at least 85% of its dental coverage allocation on Medicaid users, it had to refund the health department more than $9 million for 2021 and 2022.
Despite its early flaws, DentaQuest’s did improve its medical loss ratio from 2021 to 2022, which is the ratio of administrative costs to actual clinical services.
DentaQuest also did not meet all requirements for network adequacy as of June 2023 or June 2024. However, according to the health department report, Louisiana has a shortage of dental providers across the state.
The audit shows that for some specialties, such as endodontists, periodontists, and prosthodontists, DentaQuest contracts with five or fewer providers statewide.
In addition, as of June 2024, the program has no dental providers, including general dentists, in five parishes — Assumption, Cameron, Jackson, Madison, and West Feliciana — and 40 parishes did not have any specialty providers available.
