ADA Admits Report Comparing State Medicaid Reimbursement Rates with Private Insurance Is Flawed

On June 27, we reported that the Legislature would not be increasing the Medicaid fee schedule for dentists despite the overwhelming need and the record abundance of funds in the state coffers this legislative session.

The reason cited was that Texas HHS (HHSC) would not agree to such an increase because Texas was still paying a higher reimbursement rate than some other states.

The only research we could find on this was a 2020 ADA Health Policy Institute report entitled “Reimbursement Rates for Child and Adult Dental Services in Medicaid by State” which showed this and is included as a PDF in that article.

Success raising rates in other states

A few days after publishing the article, TDMR was contacted by a source in the dental insurance industry who was involved in efforts in other states outside of Texas to raise dental reimbursement rates. There has been success in doing so in a number of states including Louisiana, Georgia, and Kansas over the last year (see below).

They were interested in what happened in Texas.

Complaints on accuracy of ADA report

When the ADA report was mentioned, they said dentists in other states had complained to the ADA about the accuracy of the report because there was no way Kentucky was paying Medicaid dentists almost 105% of private insurance rates.

Because of the complaints, we were told that Marko Vujicic, the chief economist and vice president of the ADA’s Health Policy Institute, admitted the report wasn’t fully accurate.

HPI chief economist admits complaints valid

To back this up, there was an email written on June 28, the day after the publishing of our article, by Dr. Vujicic PHD and circulating around with his permission.

We were forwarded a copy and reproduce the relevant text here:

Re: KY, look, we are pretty open about our shortcomings with MCO data and also transparent on what we compare Medicaid rates to. The data are not perfect, each update we try to do better and rest assured, we are about to get new data in the coming weeks and will address some of the methodology challenges. Do I wish this happened quicker, yes, but we are at the mercy of outside data agencies too. We are not going to get MCO Medicaid data, it is just going to be the FFS Medicaid rates. Again, that is all the data we have. I would love it if MCOs had to disclose their data but they don’t. We will be using dentist charges this go around in the denominator, as that will be a better comparison vs. paid amounts. And I assure you we will look to make things even clearer in the write up.

Feel free to pass this along. I appreciate the feedback, we are not ignoring it, trust me.

Did the ADA’s petard hoist us here in Texas? We simply don’t know.  We don’t have all the rates to compare ourselves and determine their accuracy.  But clearly, an ADA report has authority and we would hope it to be accurate.

Medicaid Gains in Other States

One Response

  • There was no 7.3% increase in Massachusetts for “all codes.” They increased ADULT fees by 7.3% – Child fees have only raised 0.2%(a fraction of 1%) since 2009. I have all the data and can show you that.

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