Everyone remembers the Frew case back in 2004 when the Supreme Court forced Texas to provide basic healthcare services including dental care for Medicaid-eligible children.
Reason for fee increase in 2007
For those that don't remember, let's recap. Linda Frew, on behalf of her daughter, and with others filed a class action lawsuit against the state in 1993 because it was not providing federally mandated Early and Periodic Screening, Diagnosis and Treatment for underprivileged children. There was a settlement agreement brokered by a federal court in 1996 but the state refused to have their compliance with the agreement or lack thereof monitored by the court. That fight ultimately went to the Supreme Court which threw out the state's arguments in 2004.
As a result of the Court's decision, Texas found itself having to increase fees for basic dental services to attract more dentists to service the more than 1.5 million Medicaid eligible children at that time.
Dental rates had been so low that few dentists serviced this community. The increase served its purpose and many more dentists joined the program. These rate increases came into effect in September of 2007 as part of the Frew Expenditure Plan. Those 2007 rate increases are shown in the PDF to the right.
Fees decrease by 2% since 2007
As we fast forward to today, some 15 years later, what do we find? Unsurprisingly perhaps we discover that these 2007 fees have been decreased by on average 2% for those basic dental services.
Yet provider expenses have increased by 36% since 2007, the inflation rate from 2007 to 2022 before this current inflationary spiral. Providers have a knife to their throats. Expenses are going up, up, up but rates decrease. Something has to give.
It reminds one of the story about how you boil a frog. If you throw the frog into a pot of boiling water, he will jump out. But if you put the frog in the pot with temperate water and slowly increase the heat, you boil that frog real nice.
2007 Rate Increase from the Frew Expenditure Plan
Financial pressure on providers
Fortunately or unfortunately, many dental practices in Texas are now dedicated to servicing the Medicaid-eligible community as difficult as that sometimes is. They are in the pot of slowly heating water that is nearing boiling as far as fees are concerned, not to mention onerous restrictions such as the three-year rule and the problems with the Texas Medicaid Fraud Prevention Act.
We understand that the Medicaid-eligible population has grown to some 3.9 million underprivileged children which puts pressure on the state's healthcare budget. So it is understandable that the state would want to keep dental rates as low as possible.
But a fee schedule that is 2% lower than 2007? It's worse than that.
HHS graciously directed us to the Texas Medicaid dental fee schedule shown below and is available on the TMHP website.
Think getting lower 2007 fees are bad? There are fees that originated in 1992 that have gone down!
Can providers survive?
Is this fair to providers who service this community because of need not just money? We don't think so.
How can providers survive when their expenses are climbing but fees are stagnant? Providers are coming to the boiling point on fees.
Trying to survive on a fee schedule lower than it was 15 years ago or longer is unfairly asking a lot of any healthcare professional.
Fee schedule review needed
The first step that could be taken is a review of the fee schedule by HHS. As shown in the PDF below, dental rates have not been reviewed by the agency since October 2017. That's almost five years ago.
The executive commissioner of HHS, who presides over these reviews we are told, could start a dialogue with the dental provider community on the fee schedule.
It would be an excellent starting place for Texas Medicaid dentists and bode well for future cooperation.
Heaven forbid the matter should go back to the Supreme Court.