The Texas Medicaid dental landscape faces a dire financial paradox. While costs for essential supplies, staffing, and real estate have surged dramatically, Medicaid reimbursement rates have stagnated below 2007 levels. Dental supply costs have increased by up to 98%, staffing salaries by over 50%, and lease costs by nearly 44%. These financial strains threaten the viability of dental practices dedicated to serving Medicaid patients, risking reduced access to quality care for the most vulnerable populations.
Large providers bear the burden of treatment for the vast majority of Medicaid-eligible children in the state. Those numbers have gone down since the end of the PHE with almost a million children being left off Medicaid rolls for procedural reasons rather than ineligibility. The dental profession has been facing a staffing crisis like never before with a shortage of dental hygienists and dental assistants. Hiring and wage costs have escalated commensurately to attract qualified individuals. Lastly, inflation has increased dental supplies and equipment costs to a new range. Yet, Medicaid dental fees have been at a below 2007 level for years.
This disparity is most easily seen when comparing 2007-era costs with the current situation. TDMR recently received a comparison of some of these expenses.
Staffing Costs
Since 2010, the salaries for various roles have surged:
New Registered Dental Assistant (RDA): Increased by 54.6%, from $9.78 to $15.12.
Experienced RDA (3+ years): Jumped by 44.2%, from $13.43 to $19.37.
Front Office Staff: Rose by 53.5%, from $14.37 to $22.06.
Office Manager: Climbed by 43.0%, from $18.75 to $26.82.
Dental Biller: Went up by 35.2%, from $17.20 to $23.25.
Real Estate Lease Costs
Real estate costs for dental practices have also increased. New lease costs per square foot have risen by 43.9%, from $15.50 in 2007 to $22.30 in 2023.
Existing leases, with an annual 3% increase, have compounded to a 41% rise from 2007 to 2024.
Supply and Material Costs
The cost of dental supplies has also seen a significant hike since 2010.
Here are some examples:
Surgical Masks (100ct): Increased by 94%, from $6.95 to $13.49.
Latex Gloves (Box): Skyrocketed by 118%, from $5.45 to $11.87.
Prophy Cups: Jumped by 64.9%, from $39.40 to $64.99.
Prophy Paste: Jumped by 67.4%, from $24.79 to $41.49.
Flowable Composite Material: Almost doubled, increasing by a remarkable 98.1%, from $52.54 to $104.07.
Sealant Material: Shot up by 58.5%, from $64.99 to $102.99.
Can practices survive with fees lower than 2007?
It is not possible in the long term.
The Texas Health and Human Services (HHS) has failed to adjust Medicaid dental fees in line with inflation and rising costs, contributing significantly to the current crisis. This oversight not only threatens the financial stability of dental practices but also compromises the quality and accessibility of dental care for Medicaid recipients.
Dental healthcare professionals charged with the care of children can’t survive on a fee schedule set in 2007, which has only declined by 2% since then.
Other states have helped dental providers
Several states, such as Colorado and Louisiana, have answered the call to increase fees to address these issues for providers.
Texas in the process of review
Texas HHS Provider Finance will review Medicaid dental fees later this year, according to Texas HHS.
The state is not hurting financially, with another budget surplus expected for the upcoming 89th Legislature. This was estimated to be $21.3 billion by one source recently.
Medicaid dental spending, not including orthodontia, by the state has remained below 2011 levels, the last year of fee-for-service, according to the DMO premium reports on the Texas HHS website (see chart compiled by TDMR). Spending on orthodontia has gone down by over 99% from over $250 million a year in 2011 to under a million in 2022.
Texas Medicaid dental providers need help.
Great Article. The increased numbers I’m seeing here are definitely on par with what I am seeing across the board. Fees have to increase significantly to keep pace and should have a built in increase year over year to take into account inflation.
All very true. We are struggling to keep our staff. Our staffing costs are substantial higher than the upper range of the estimates in the article. Our lease is expiring soon. We are considering moving to a more affluent area of town and no longer accepting Medicaid, selling, or just closing down.
I had heard that a Texas State Senator whose father was an Orthodontist back in 2007 was the one that sank the last proposed fee increase. I’m sure her father had a difficult time making a living without taking Medicaid. I believe she referenced her father’s complaints from that time period. Got to love politicians.
Short answer is no. Fees need to increase before they completely kill access to kids across the state.
We are a provider of medicaid children’s dental in TX and we are having an extraordinary time keeping up with medicaid reimbursements vs the cost of running and staffing a dental office – Unless TX raises fees and keeps up with inflation – kids on Medicaid in the state of Texas will suffer since they will NOT find providers readily available to treatment these high risk patient population
Great article.
Even though the state has a surplus. Its happening in New mexico as well. The state also has a surplus.
We are a provider of Medicaid in New Mexico and we are having a hard time keeping up with the medicaid reimbursements vs the cost of running and staffing a dental office.
The stat of New Mexico will also suffer.
we have similar TPA dental providers.
Is it a state problem?
Is it a TPA problem?
Is it a legislative problem?
where can we start?
I am struggling to keep staff with these fees. Sometimes I contemplate closing and hanging up my hat.