Our article earlier this month, DMO Credentialing Practices Continue to Burn Dental Providers, on the continuing problems with DMO credentialing drew a quick response from several frustrated Texas dentists — and the stories are all too familiar. “What a mess, … Read More
TDMR took a look at the most recent enrollment figures for Texas Medicaid on the HHSC website. HHSC used to keep this up pretty well, but for some reason, the latest data is from July 2025. What we discovered was … Read More
Back in early 2023, TDMR reported on the credentialing mess involving TMHP, UnitedHealthcare Dental, MCNA, and DentaQuest. We wrote the following articles, including filing a complaint with OIG on the continuing debacle. Credentialing Still a Disaster for Texas Medicaid Dentists … Read More
Last Thursday, TMHP posted the revised Medicaid dental fee rates on its website. Finally. We were continuously told that the DMOs had updated their fee schedules, but nothing had been posted on TMHP, which is where they were supposed to … Read More
We’ve watched. We’ve waited. We’ve inquired numerous times to see when and if the Medicaid dental fee schedule would be modified as a result of the July 22 public hearing. Notification supposed to have been posted Last Friday, around 1 … Read More
TDMR has been in contact with HHSC Provider Services over the last week to find out when or even if there would be any revisions to the Medicaid dental fee schedule before the September 1 implementation deadline, as stated at … Read More
At the end of July, WalletHub released a report on the “Best & Worst States for Health Care (2025).” WalletHub is a personal finance website and mobile app that provides users with tools and resources to manage their credit and … Read More
As we reported in our last story about the fee schedule, Texas Health and Human Services Commission (HHSC) Provider Finance was holding a public hearing to receive comments on the proposed Medicaid reimbursement rate changes, including the long-awaited dental rate … Read More
The Kansas legislature recently took a major step forward to improve Medicaid dental care by approving a major increase in its Medicaid dental fee schedule. The increase became effective July 1. Fees increased up to 50% Fees for exams are … Read More
The Health and Human Services Commission (HHSC) has released the revised schedule of Medicaid dental fees as a result of the state budget amendments as follows: Rider 24 directs HHSC to increase reimbursement rates for maternal fetal medicine radiological services … Read More
The state budget signed by Gov. Abbott on Sunday includes a provision approved by the Texas legislature that adjusts Medicaid dental reimbursement rates for a selected group of procedure codes, which will greatly benefit dental providers. According to the TDA, … Read More
After 18 years of no increases in Medicaid dental fees, Arkansas has taken meaningful legislative action to increase Medicaid dental reimbursement rates — a move that providers and advocates have long awaited. Fee increase now law Signed into law on … Read More
And the story rolls on. The Delaware Supreme Court this week ruled against insurance giants AIG, ACE, and Lexington Insurance, upholding a lower court’s decision to order a new trial in their dispute with Conduent State Healthcare (ACS/Xerox/Conduent) over coverage … Read More
Texas is grappling with a critical shortage of healthcare workers, including dental professionals, exacerbating dental access and provider issues across the state. A recent Newsweek article, “How Texas Could Solve Its Health Care Worker Crisis,” highlighted these problems, mentioning a Becker’s … Read More
According to a news item on the Husch Blackwell website, Texas filed suit against the federal government on December 11 to stop the recoupment of $83 million in Medicaid payments given to hospitals several years ago. The issue revolves around … Read More
The Texas Health and Human Services Commission (HHSC) plans to request $300 million from the state legislature to address extensive delays in processing Medicaid applications. This funding would facilitate hiring over 1,000 new employees and modernizing the outdated and heavily … Read More
While DentaQuest limits its Medicaid network in Texas and threatens to boot over 100 providers from its network in urban areas, yesterday, its Canadian parent company, Sun Life Financial Inc., crowed about its share price reaching an all-time high, boosted … Read More
California has problems. We all know about them. Now, they’ve added DentaQuest as another one for their Medicaid (Medi-Cal) program to the apparent detriment of state dental providers, considering the company’s situation in Texas, Louisiana and other states. This past … Read More
TDMR has received a missive from a concerned dentist, which we are publishing. It sums up the frustration and intense concern about DentaQuest’s recent actions in limiting its network, including a threat to remove over 100 urban providers. This prodigious … Read More
It is a common misconception that your voice does not matter in big government. Unfortunately, it is that misconception that allows big governments to continue in a state of blissful unawareness about the need for change in their policies and … Read More
Texas Health and Human Services Provider Finance quietly posted its much anticipated legislated biennial review of Medicaid dental fees early last week. Well, maybe it was earlier, but it was only noticed early last week. It was found tucked into … Read More
Our story on foreign-owned DentaQuest’s limitations on dental care access for Medicaid children in Texas has sparked outrage among dental providers, leading to an outpouring of angry comments. Many practitioners shared their frustrations and experiences, highlighting how the restrictive policies … Read More
In a stunning move last week, DMO DentaQuest sent out a letter (copy below) to its Medicaid provider network that as of October 15, it would “be limiting the number of additional” general and pediatric dentists into its network in … Read More
The Sunshine State now joins the growing list of states that have recently increased dental Medicaid rates. Florida’s commitment to “live healthy” for its citizens On October 1, several health care bills came into effect in Flordia called the ‘Live … Read More
TDMR is pleased to announce that we received confirmation today from Texas Health and Human Services that, as of yesterday, DentaQuest is no longer paying a one-surface fee for non-interproximal two-surface fillings and will be reprocessing previously denied claims. Win … Read More
In July, the Louisiana Legislative Auditor’s office published a scathing audit review of DentaQuest’s performance as one of the two dental maintenance organizations with Louisiana Medicaid. It fined the company for its poor performance. FYI, Louisiana calls them dental benefit … Read More
This week, a federal judge in Tennessee found that an algorithmic system similar to the one in Texas and designed by the same company illegally denied Medicaid benefits to thousands of Medicaid-eligible individuals. The TennCare Connect system, developed by Deloitte, … Read More
Justice for Medicaid dentists and orthodontists, whose lives, reputations, and practices were ruined in the great Texas Ortho Debacle, appears to be coming—slowly, but surely. Legal losses continue to mount for Conduent State Healthcare LLC, spun off from Xerox in … Read More
More comments have poured in as a result of our last article containing remarks from dentists about the state of their Medicaid practices. Medicaid dentists are having difficulty grappling with the crushing weight of rising costs and woefully inadequate Medicaid … Read More
TDMR’s recent article on the financial challenges facing Medicaid dental practices in Texas has struck a chord with a number of providers who left comments. We don’t often receive a spate of comments after an article, but this one certainly … Read More
The American Dental Association’s Health Policy Institute (ADA HPI) recently published its “Economic Outlook and Emerging Issues in Dentistry” report for the second quarter of 2024. This comprehensive survey offers valuable insights into the current economic conditions, staffing challenges, and … Read More
This week, several media outlets, including KXAN, have reported on U.S. Rep. Lloyd Doggett‘s release of correspondence from the Centers for Medicaid and CHIP Services (CMS) to Texas regarding significant delays and backlogs in processing Medicaid program eligibility. These delays … Read More
TDMR has learned that Texas Health and Human Services Provider Finance will conduct its biennial review of the Medicaid dental fee schedule later this year. The review will be presented at a rate hearing in November, with a proposed implementation … Read More
This past week, TDMR came across the State Of Texas Medicaid Managed Care Dental Rate Setting reports on the Texas HHS Provider Finance web portal. These are the third-party actuarial reports compiled for Texas HHS to recommend the per-member, per-month … Read More
The Colorado Dental Association (CDA) announced at the end of April that Gov. Polis had signed the 2024/25 state budget, which includes $78 million in “meaningful reimbursement rate increases for Medicaid dental providers.” The increased fees schedule goes into effect … Read More
TDMR recently received the 2023 statistics of active and enrolled Medicaid dentists from a freedom of information request to Texas Health and Human Services. These statistics come from the THSteps Active and Enrolled Dental Provider Participation Report (downloadable PDF below), … Read More
BY KAREN BROOKS HARPER, Texas Tribune APRIL 26, 2024 “State’s premature release of bid proposal info touches off new battle over $116 billion in Medicaid contracts” was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs … Read More
TDMR has compared the fee schedules for TMHP THSteps Medical services from 2019 and 2024 to determine if doctors are being hampered by the same reluctance from Texas HHS to increase fees that have plagued Medicaid dentists over the last … Read More
REPUBLISHED FROM THE TEXAS TRIBUNE By Karen Brooks Harper, The Texas Tribune April 18, 2024 “Proposed changes to state Medicaid plans could shake up health coverage for 1.8 million low-income Texans” was first published by The Texas Tribune, a nonprofit, … Read More
TDMR received notification of a new report from Texas HHS on the End of Continuous Medicaid Coverage in Texas. The upshot for children who were under Medicaid coverage during the public health emergency (PHE) is that, at present, some 999,524 … Read More
