Agency for Persons with Disabilities seeks new procurement, emphasizes prevention and community partnerships for dental care

The Agency for Persons with Disabilities briefed the Appropriations Committee on its statewide dental program for individuals with developmental disabilities, described obstacles to procuring a vendor and outlined priorities for a revised procurement focused on prevention, community partnerships and care coordination.

Lorena Fulcher, assistant director of operations and programs at APD, said APD provides dental supports through multiple mechanisms including the iBudget waiver, an APD dental allocation and connections to Medicaid dental managed care plans. She said the agency has historically acted as a payer of last resort, authorizing dental treatments not covered by Medicaid, Medicare or private insurance and connecting individuals to emergency care when needed.

Fulcher reviewed the program’s history: in 2012 the Legislature appropriated $2,000,000 in nonrecurring funds for a contract; that annual appropriation rose to $3,000,000 through 2022. In 2022 APD received an additional appropriation to conduct a competitive procurement and research best practices. Fulcher said APD issued a solicitation in January 2024 that drew no responsive bidders; the agency revised its approach and released a new solicitation on Oct. 24, 2024 for up to $11,500,000 that emphasizes a teaming model, community outreach, teledentistry, acclimation visits and a data management system for vendor reporting.

Fulcher said APD’s analysis showed an expenditure drop around fiscal year 2019 likely tied to the Agency for Health Care Administration’s implementation of a Medicaid dental benefit in December 2018 and the subsequent availability of dental services through Medicaid dental plans. APD reported rising expenditures in 2022–23 and 2023–24 to ensure clients could access services while procurement work continued.

Senators asked whether services continue during the solicitation and whether APD has assisted clients affected by Medicaid redeterminations. Fulcher said APD can operate the dental program if procurement fails and that services are being authorized now through APD funding sources and the iBudget waiver. On Medicaid redeterminations, she said eligibility is determined by the Department of Children and Families and APD collaborates with DCF, shares data with waiver support coordinators and assists individuals applying for Medicaid, but she deferred to DCF for redetermination policy.

Public comment during the hearing amplified the issue of Medicaid redeterminations for APD clients. Melissa Mezada, representing a provider, said her organization tracked hundreds of iBudget waiver recipients who were disenrolled from Medicaid during the unwinding and described administrative burdens and service interruptions. “These are folks with developmental disabilities … If they're dropped from Medicaid they can't access their services,” Mezada said, adding her agency had hired staff and filed fair‑hearing requests to remedy cases.

The Florida Dental Association’s chief legislative officer, Joanne Hart, told the committee the Medicaid dental program is struggling to recover, expressed concern about an AHCA waiver submitted to CMS that would alter administration and funding for certain dental services, and urged changes to improve provider access to facilities and increase facility reimbursement for dental procedures.

APD said it will evaluate solicitation responses for community‑based teaming approaches, require a vendor data management system, and continue to operate or authorize services while procurement proceeds.