11 States Increasing Medicaid Dental Reimbursements, Texas Not One of Them

The American Dental Association reports that 14 state legislatures have passed progressive legislation regarding Medicaid dental care this year, partly due to increased budget surpluses in those states. Connecticut, Georgia, Illinois, Maryland, Mississippi, Missouri, Nebraska, South Dakota, Tennessee, Vermont, and Virginia are increasing Medicaid dental fees in some manner.

According to the ADA, this boon is due in part to state dental societies “being highly engaged on the issue” leading to positive legislation being passed in those 14 states and three more with legislation pending.

Unfortunately, Texas is not one of them despite its huge budget windfall.

Here is the list provided by the ADA.

These 14 states have enacted laws regarding dental Medicaid:

Lawmakers in the state approved a 25% dental Medicaid fee increase.

The Florida Dental Association advocated to keep the state’s dental Medicaid program from being merged into the state’s medical managed care Medicaid program. The state association accomplished this despite a strong push from state Medicaid officials and in doing so, ensures that Florida’s Medicaid program will continue to be well-funded and accessible.

The state budget provides for an increase in reimbursements for select dental Medicaid services.

The state budget includes $10 million to increase rates for preventive dental services.

A new law extends adult enrollees’ dental coverage from emergency-only to more comprehensive care.

A new law now requires Medicaid to cover dental care for adults with intellectual or developmental disabilities who reside in intermediate care facilities.

A new law in Maryland adds diagnostic, preventive, restorative and periodontal services for adults whose annual income is at or below 133% of the federal poverty level. Previously, the state had no dental coverage for adult enrollees aside from pilot programs. Funding is also included to raise reimbursement rates for dental services.

The state approved fee increases for restorative services performed on Medicaid patients.

Lawmakers adopted one of the largest dental Medicaid fee increases in the state’s history this year. Reimbursement rates will now be set at 80% of the average 2022 fees, making them more in line with fees paid in commercial dental plans.

State lawmakers adopted a 10% dental Medicaid fee increase and also eliminated the $750 annual spending limit for adult dental services. Also adopted was the plan to combine the state dental program into the state’s medical managed care organization.

South Dakota
South Dakota lawmakers approved the plan to set dental Medicaid fees at a percentage of normal and customary fees with the hope that more dentists will be able to participate in the program.

Following the passage of its state budget, Tennessee’s Medicaid program will begin adding comprehensive dental coverage for the state’s 600,000 adult enrollees in 2023. Additionally, fees will increase more than 6.5% for preventive, endodontic and other services. The state also funded a pilot program to bolster access frameworks by funding dental school programs serving low-income patients, enhancing the use of community dental health coordinators, incentivizing dentists who agree to practice in rural areas, and also helping to cover costs of enrollees’ transportation to dental appointments.

The state budget included $1 million dedicated to dental Medicaid funding. The state also eliminated limitations on dental preventive services in Medicaid.

The state budget deal includes a 30% fee increase in provider dental Medicaid reimbursement rates.

These three states have pending legislation:

The state is moving to add more comprehensive adult enrollee dental coverage. Currently there are emergency-only adult benefits.

The proposed executive budget includes an investment to replicate the success of the Healthy Kids Dental for all Medicaid enrollees in the state through a single combined managed care contract, extending access to dental care for over 3 million Michiganders. The final budget bill has yet to be agreed upon by the Michigan House and Senate.

New Hampshire
Lawmakers voted to enact a law extending adult dental coverage beyond emergency-only. Final approval by the governor would be the last step in securing this benefit.

13 Responses

  • It’s disheartening to hear that texas is not considering a Medicaid fee increase. I’ve been a Medicaid dentist for many years and have seen reimbursement dwindling year after year while overhead has been skyrocketing. Now with inflation out of control, it is becoming nearly impossible to run a practice. In the end, it’s the at-risk and high need population that is going to suffer with these decisions. Please consider raising texas Medicaid fees to, at a minimum, combat the rising inflation.

    • I am very concerned that Texas has chosen not to increase reimbursements for Medicaid. Medicaid reimbursements are already low, and it’s ridiculous that they are not atleast keeping up with normal inflation. But especially now when inflation is running super high, there should absolutely be an increase. Medicaid patients deserve the improvement of care that will come with increased payment for services.

  • Texas has not increased its Medicaid fees for 16 years! Meanwhile, everything else has gone up substantially since then. Profit margins are so razor thin nowadays that some months we actually lose money working. It makes no sense. For 15 years I have been a Medicaid provider and not sure if I can continue if they aren’t increased. The state will lose many providers and it will negatively impact the economy tremendously if reimbursement fees are not increased. I hope our state leaders increase reimbursement fees. It’s the best thing for these kids to have good options for providers instead of limited overcrowded and overworked options. At minimum I hope they do the right thing for the economy.

  • Texas wants to be the most desirable state to live in the country yet appears to be on track to fail at providing basic services to people in need. With operating costs increasing at such an alarming rate, how much longer will dentists be able to treat Medicaid patients? If many dentists decide that they can no longer treat these patient’s then how long will it take the state to respond and will any dentists return to the program? The budget decisions today will have large future ramifications. I hope the state continues to be the leader it claims to be and make the necessary changes to fees so that the people can get the healthcare they need.

  • Basic supply and demand.

    Theyre are more than enough dentists and corporations who flocked to Texas in 2008 after the fee increase.

    Why increase fees when there is a medicaid mill on every corner?

    • Exactly. Almost every encounter I have had with Texas Medicaid confirms my belief that those who run it would be happiest if all treatment was provided for free and treating doctors committed suicide en masse, to be replaced with fresh graduates to abuse.
      Medicaid hates dentists (apologies to Kanye).

  • Texas has more than enough resources to do the right thing for the patients, and the provider as well. Offices are losing money and will close down due to the inflation we’re currently seeing and it’s increasingly difficult to run a practice. Especially after reading the comment that it has been 16 years since a fee increase, that’s ridiculous. So much has changed in 16 years with staffing costs and supplies costs where it’s impossible to run an office. When offices close down, it will be the patients who suffer.

  • All of us who accept Medicaid to serve the community are finding it more and more difficult to serve those communities with rising costs of materials and technologies. It is a dis-service to the communities who need this care as some of my colleagues and myself are contemplating no longer participating with medicaid.

  • Basic Texas Politics first, children’s safety and health last. With staff wages shooting up, staggering inflation and soaring supply costs the writing is on the wall for us. Sadly, in the very near future, it just will not make sense to do business in this state for much longer. In 16 years, fees have gone DOWN and every year more restrictions are imposed onto providers, making proper dental treatment almost impossible.

  • Texas needs to get on board. These fee increases will mostly help the underserved communities. With the high prices and inflation we are having right now, we have to make cuts somewhere if fees do not increase. Cutting staff has been the main solution. We have had to make cuts in the last few months. At some point, when we have no other options to compensate for the high costs, we will have to shut the office down…which will just hurt the community in need of our services.

  • It is so sad to see Texas not being on board with these fee increases ;especially during these extraordinary times
    where inflation is sky rocketing .It is only common sense to try to both help the economy and allow us as providers serve this underserved community which are in need of care the most!!Instead we are here worrying about how can I afford to keep quality trained staff and afford to keep my doors open with costs increasing astronomically yet reimbursement getting worse and worse.

  • Texas needs to step up. Medicaid dentistry in this state is at a breaking point. Something must be done.

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