After our article about the need for a review of Medicaid dental fees was published in May, we received a number of comments from dentists about how the lack of a fee increase is impeding service to their clients and their practices.
Comments after articles are published aren't often read so we are republishing them here for maximum visibility.
Since 2015 I have had the opportunity to serve patients with Texas Medicaid. There have been many changes since that time and none appear to be in the interest of the patient or provider. Costs have been skyrocketing, especially in the last two years. The three-year rule places a significant burden on treating dentists. Three years is a very long time to essentially be required to ‘warranty’ a restoration for a patient that may not adhere to any guidance involving diet and home care. Supply chain and runaway inflation issues are driving up costs of nearly every piece of equipment, material, and disposable required to properly treat patients. Inflation and rising gas costs are being felt by staff and new hires. This has led to rapidly increasing pay rates to retain or hire new staff. Soon, it may be necessary to reduce staff as wages and costs of doing Medicaid dentistry continue to increase while putting an increased burden on the provider without even reviewing the current fee schedules. - Concerned Medicaid Dentist
I am a Texas dentist and have been largely serving the Medicaid population for many years. Every year our overhead has been increasing substantially and more recently, with runaway inflation, it's really getting out of control. It is reaching an inflection point in which it is becoming financially infeasible to keep treating the Medicaid population. On top of the low reimbursement, there are also additional hurdles such as the ridiculous 3yr rule which makes it near impossible to properly treat this underserved population. Please consider increasing fees, at a minimum, back to the 2007 levels, to allow providers to continue care without unnecessary financial strain. Thank you! - FARSHID SIAMI DDS
I started practicing dentistry in Texas in 2012 and provided care to the Medicaid community. Each year I’ve seen increases in prices and overhead while there have been decreases in fees. Covid-19 had even a greater impact on the supply price increases. Now we are facing some of the worst inflation numbers in years and are expected to survive with the current fees. I personally have had to reduce my staff size. It’s a privilege to serve the underserved Medicaid community but without some help, it will be difficult to continue. What is happening will actually hurt the patients that need the care. - MICHAELS
This is disturbing to see the actual numbers. Unfortunately, these nonstop decreases in fees will only hurt the patient and also create an environment where many dentists are put in terrible situations by having to see more and more patients just to stay afloat. Nothing good can come of that. Regulate all you want, but pay fair and reasonable fees. I have been a Medicaid provider for 15 years and every single year they have reduced them. I just don’t see how I can continue if this trend doesn’t end. - J GONZÁLEZ
I have been a Medicaid provider in Texas since 2014 and it honestly has been disheartening to try to provide the same level of care this patient population deserves with these decreasing fees. I have had to decrease my staff numbers and cut back on supply orders due to increasing costs of wages and materials which greatly limits how many patients can be treated. I feel like my hands are tied and at this point, I am not sure how much longer I can stay on as a Medicaid provider. Please consider increasing fees so that we can continue to provide care to these deserving patients. - DR. M
I remember years ago in dental school I attended a lecture on supervised neglect. My professor repeatedly reminded us of our oath to do no harm. The three-year rule is the ultimate definition of supervised neglect. These dangerous and unethical rules keep hard-working doctors from providing patients with the care they need and deserve. This coupled with skyrocketing costs will soon prohibit an entire demographic of children from receiving basic dental care. - MICHAEL MCCARTOR DMD
I have been providing dental care to the largely Medicaid population here in Texas for a number of years now. And unfortunately, as this article states, I have only seen the fees decrease over time. With inflation rising; office leases soaring; supply shortages and bottlenecks (esp last couple of years due to covid), and thus increased pricing; staffing shortages, and then directly/indirectly increased staff wages… I am very concerned about how much longer I can remain a Medicaid provider–I am seriously needing to consider switching to only private insurance and/or fee-for-service. How am I and other dentists supposed to practically and realistically keep on providing good, continuous care for an already underserved population? If Medicaid fees continue to decrease, we will soon have a major crisis on our hands: fewer and fewer dentists being able and willing to logistically care for a large portion of our population that need our help and services, and Medicaid children suffering the negative impact of this through no direct fault of their own. - DR. JOHANNE
Show a need for change
In politics, a letter from a single constitutent on any issue is taken to represent the voice of many that did not take the time to write. So these comments probably represent the voice of very many Medicaid dentists with the same thoughts and problems.
More input is welcome
We welcome further comments or emails to firstname.lastname@example.org about Medicaid dental fees.