UPDATE: The Texas HHS Open Records Office sent TDMR a further document that contains only the active number of dentists in the Texas Medicaid program from 1996 to 2022. The previous document used contained both active and inactive combined. This article has been updated to utilize this data.
TDMR received the latest figures on THSteps Enrolled Dental Providers from an open records request filed with Texas Health and Human Services. The initial report was both active and inactive providers lumped together but the further report contained only active providers.
Dental provider enrollment since 1996
The report provides historical data on quarterly and annual dental provider enrollment from 1996 when the Frew case consent decree came into force. The report breaks down participation into low-volume, mid-volume and high-volume providers. A low-volume provider serves less than 30 Medicaid patients, mid-volume 30 to 99, and high volume over 100.
It is a historical fact that back in 1996 26% of active Medicaid dental providers were low-volume providers. This percentage has dwindled to 17% and 18% in the last few years, with high-volume providers picking up the slack.
In 1996, Texas Medicaid had 1,921 active dental providers. This number dwindled to 1,592 in 2002 and back to 1,743 in 2006.
2007 fee increase boosted the number of Medicaid dentists
In late 2007 the Frew Expenditure Plan was proposed and dental fees were substantially increased.
The number of active Medicaid dentists then rose every year from 1,779 in 2007 to a high of 4,156 in 2019.
Active dental providers from 2019 to 2021 roller-coastering
However, between 2019 and 2021, active provider totals have become stagnant, dropping in 2020 to 3,982 but going back up to 4,140 in 2021.
While quarterly figures are given for 2022, the final annual total will not be available until April 2023. As quarterly figures generally do not represent the final totals in any year, it is difficult to predict the final figure for 2022.
But clearly, 2022 quarterly active dental numbers do not show any great increase and possibly a drop in the number.
Inflation, staff problems exacerbate situation
With inflation and the difficulty in finding and keeping staff over the last year, coupled with a dental fee schedule that has only been reduced by 2% since 2007, it would not be surprising if this trend does continue, especially for low-volume providers. We've already reported on this.
Medicaid enrollment increased by 26.4%
During this same period of the pandemic, child enrollment in Texas Medicaid increased by 26.4%, according to a just published online article. You can't do more with less.
In the previous iteration of this article, we stated that "some 7,000 dentists treating 4.2 million children?" Well, it is worse than that. There is only about 4,000 dentists available to treat some 4.2 million children. 100,000 kids for every active dentist. Can't be done, can it?
Fixing the fee schedule
Fixing the dental fee schedule would certainly be a step in the right direction to increase provider enrollment. It only makes sense that low-volume providers would drop Medicaid patients when they can replace them with higher-paying clientele. Even private dentist are increasing their rates to cope with inflation.