DentaQuest’s Canadian parent company, Sun Life Financial, wants better financial results from its U.S. dental business, according to an August earnings call. Texas dentists are under pressure from DentaQuest audits seeking tens of thousands of dollars in repayments over alleged … Read More
Vanessa Melendez had been going back and forth with the state over her family’s Medicaid and food assistance applications for months when the Houston mom learned she was pregnant with her third child. She submitted a new application for Medicaid … Read More
Texas children have the highest reported rate of oral health problems in the country, according to data from the 2024 National Survey of Children’s Health. The survey found that 21% of Texas children ages 1 to 17 experienced one or … Read More
A new report from the American Dental Association’s Health Policy Institute suggests that while dentists are becoming more optimistic about the economy, the financial pressures facing dental practices have not eased. The State of the U.S. Dental Economy – Q2 … Read More
The Texas Supreme Court has issued a significant decision that could reshape how Medicaid fraud cases are pursued in Texas, ruling that the State cannot simply point to an alleged regulatory violation. Instead, it must also prove that the alleged … Read More
Delta Dental is again eyeing Texas Medicaid. TDMR has received recent reports from several Texas dentists indicating that Delta Dental is reaching out to recruit providers as part of a planned expansion into the Texas Medicaid market. According to information … Read More
Brident Dental & Orthodontics appears to be reducing its presence in Texas. TDMR has received several independent reports indicating that Brident locations in Texas are being offered to prospective buyers. One source familiar with the process described seeing a substantial … Read More
OIG recently published the following article on its website. Providers should know that AI is on the job at OIG now. New tech tools increase OIG productivity Teams within the OIG Data Operations Division recently launched new efficiency-focused tools … Read More
For those of you still following this 15 year orthodontic debacle, in a long-awaited decision, the Fifteenth Court of Appeals has reversed a trial court’s ruling and held that Alexandra Alvarez, Joshua LaFountain, and Christine Ellis, DDS, are not entitled … Read More
DentaQuest has named a new dental director for its operations in Texas. Dr. Ronke Ogunbameru, a board-certified pediatric dentist based in Mansfield, will take the reins of the troubled Texas DMO. The Sunlife-DentaQuest press release sent out Thursday says that “she … Read More
The following is a press release from the Office of the Governor. ————————————- Governor Greg Abbott today sent a letter directing the Texas Health and Human Services (HHS) Office of Inspector General and the Texas Health and Human Services Commission (HHSC) … Read More
TDMR has received and confirmed a new complaint about DentaQuest regarding the DMO’s handling of primary tooth extractions. The issue has now been independently verified by three additional dental offices, indicating it is not an isolated incident but a recurring … Read More
Texas Health and Human Services has sent notifications that it is now accepting applications to serve on the State Medicaid Managed Care Advisory Committee for a two-year term. The first line says it all. “If you’re interested in issues related … Read More
We have received numerous emails asking, “What can we do about DentaQuest’s [name your problem]?” Beyond quitting, we need a new adage. Yes, “the squeaky wheel gets the grease,” but a broken wheel needs more than grease because DentaQuest is … Read More
Sun Life, the Canadian parent company of DentaQuest, has reported a $64 million drop in income for its U.S. dental and group benefits segment. Their explanation for the dental drop? Americans use too much dental care. Yep. On the Q3 … 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
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
A Medicaid dental provider with multiple offices in the state contacted TDMR this past week, voicing serious concerns about recent restrictions imposed on their practice by Canadian-owned DMO DentaQuest regarding the use of substitute dentists. Violation of Texas Administrative Code … Read More
Recent legislative actions in North Dakota and North Carolina—both Republican-led states—highlight growing nationwide recognition of the urgent need for Medicaid dental reforms. These developments underscore a critical issue facing Texas: inadequate dental Medicaid reimbursement rates, which continue to hinder staffing, … Read More
TDMR was contacted a few days ago by a concerned dentist who was unaware of which Medicaid reimbursement rates were changing as part of the upcoming March 1, 2025, fee adjustments. These rolled out as a result of the biennial … Read More
According to the latest online Health Resources & Services Administration statistics, Texas ranks behind California, Arkansas, Missouri, and Florida as the states with the most dental health professional shortage areas (DHPSAs). Texas currently has 265 areas designated as such. The HRSA … Read More
A January 2025 oral health survey conducted and published by personal finance website WalletHub has ranked Texas as one of the states (the District of Columbia was included in the survey) with the worst oral health in the country. Source: … 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
TDMR received this story from Dr. Hector Alvarez in Eagle Pass earlier this month. We found it informative and inspiring in his and his family’s dedication to helping the underserved and needy in his county. It speaks to the quality … 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
In the Texas Health and Human Services Commission (HHSC) hearing held on November 12 about the proposed rate changes to the Medicaid dental fee schedule, eleven dental professionals, including a representative of the Texas Dental Association, testified, either in person … Read More
ACS State Healthcare and Conduent State Healthcare LLC have filed an appeal with the Texas Supreme Court, hoping to prevent a trial in which it must defend its flawed Medicaid prior authorization process, which rubber-stamped hundreds of millions of dollars … 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
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
In our last article regarding the HHSC Provider Finance department biennial review of Medicaid dental fees, we published a letter sent to HHSC by a dentist to complain about the lack of real increase in rates made. Hot issue We … 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
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
REPUBLISHED FROM THE TEXAS TRIBUNE Texas officials acknowledged some errors after they stripped Medicaid coverage from more than 2 million people, most of them children. A ProPublica and Texas Tribune review of records shows that these mistakes and others were … Read More
It’s a bad week for DentaQuest. Yesterday, according to an article in the online publication The Center Square, Louisiana legislators ripped into DentaQuest at a hearing of the House Joint Budget Committee as the Louisiana Department of Health had recommended … Read More
