DentaQuest is a “third party administrator” (TPA) for over 30 state Medicaid dental programs – and shrinking.
Massachusetts’ recent replacement of DentaQuest with Benecare was DentaQuest’s first performance-based state-booting – “The Boot State” of Louisiana appears ready to kick DentaQuest out, too.
History in Louisiana
Since January 1, 2021, DentaQuest has been one of Louisiana’s Medicaid dental benefit program managers (DBPMs), alongside MCNA Insurance. The DentaQuest contract was part of Louisiana’s effort to provide Medicaid members with dental services, following a mandate to offer a choice between at least two DBPMs.
DentaQuest’s initial contract was a three-year contract that expired on December 31, 2023. Due to performance issues, the Louisiana legislature only approved a conditional one-year extension that expires in December 2024, with a required follow-up review before further extensions. In Contrast, MCNA was granted an unconditional two-year extension to December 2025.
Results of Auditor’s report
DentaQuest’s recent (July 2024) follow-up review did not go well. Conducted by the Louisiana Legislative Auditor’s office, The audit revealed that DentaQuest failed to meet the required Medical Loss Ratio of 85% for spending on dental care, leading to a refund of over $9 million to the state.
The audit further revealed provider shortage failures across the state, particularly in critical specialties like endodontics and prosthodontics. Some areas had no dental providers, leaving many Medicaid recipients without access to essential dental care.
The LDH fined DentaQuest more than $2 million in penalties for a number of contract failures:
1. Claims and Encounter Management Failures: Including delays and performance standard failures.
2. Provider Network Shortages: Particularly in specialty areas
3. Quality Management Failures: Including timely service and medical necessity determinations.
4. Reporting Failures: Multiple instances of not submitting required reports on time.
Provider complaints included:
1. Denying medically necessary care prior authorizations.
2. Defective Peer-to-Peer Reviews (where a specialty provider is not able to speak to an equally trained peer to discuss specialty standards of care for prior authorization).
3. Delayed provider credentialing (with 12-month delays being commonplace).
While the audit showed DentaQuest has improved its medical loss ratios for 2023-24, network inadequacies remain a major problem for Louisiana’s dental health services.
What will DentaQuest’s fate be in Louisiana?
These Louisiana findings echo Massachusetts findings, leading to the ousting of DentaQuest from Massachusetts. Will Louisiana do the same?
Prior to DentaQuests Massachusetts ousting, the Massachusetts Dental Society and other organizations, including the American Alliance for Dental Insurance Quality (AADIQ), raised concerns over inadequate networks and poor service management, resulting in the state replacing DentaQuest with BeneCare for Medicaid dental coverage.
According to Dr. Mouhab Rizkallah, President of the AADIQ, “I have repeatedly indicated that every state that currently allows DentaQuest to run its Medicaid dental program should audit DentaQuest’s access to care standards against Federal Law at 42 USC 1396a(30)(A). I expect each state to find DentaQuest’s access plan consistently violates this critical Federal access law. DentaQuest should be removed until it demonstrates that it can consistently treat our vulnerable Medicaid population the way 42 USC requires – with compassion.”
As hundreds of thousands of Louisiana Medicaid recipients are dealing with access deficiencies, the AADIQ will continue to monitor Louisiana’s DentaQuest contract decision.
