This brief from the American Dental Association’s Health Policy Institute explores measurement of dentist participation in Medicaid, drawing on new state-specific data. Access the brief here. 

This article published in the Journal of the American Dental Association examined 13 million dental claims in the Virginia Medicaid program to evaluate the impact of Medicaid reform on provider participation and growth of DSO-affiliated practices. Access the article here.

In this report published by Community Catalyst, authors Reusch et al. analyze and provide recommendations for community engagement in oral health policy advocacy. In particular, the authors investigate both barriers to and successful strategies for advancing oral health equity among advocacy organizations, community-based organizations, and funders.

View the report here.

In this article published in the Journal of the American Dental Association, authors Edelstein et al. conclude that “greater parental dental service use, dental coverage, and ability to afford care benefit their children’s use of oral health care.”

View the article here.

This analysis from Health Affairs examines changes and improvements to Medicaid and CHIP dental services over the past twenty-five years. It enumerates implementation challenges and suggests solutions, which include providing evidence-based care, promoting health literacy, and improving federal-state communication for more streamlined care.

View the analysis here.

In this article, the authors evaluated the role of new Texas Medicaid reimbursements for preventive dental care use for caries-related surgery, sedation, and emergency department visits. The authors report that “increased preventive care visits led to increased sedation visits … and decreased emergency department visits for children aged 9 years and younger.”

View the article here.

This graphic displays demographic breakdowns of dentists participating in Medicaid or CHIP by state, gender, age, specialty, race/ethnicity, and affiliation with a dental service organization, as well as percentage of all dentists participating in Medicaid or CHIP.

View graphic here.

This graphic shows dentists’ practice patterns based on the dental schools from which they graduated. You can view the percentage of alumni from each school who participate in Medicaid or CHIP, as well as the percentage who are affiliated with a dental service organization.

View graphic here.

This report discusses the ways in which California, Pennsylvania, and Connecticut are incentivizing their Medicaid plans and providers in an attempt to innovate pediatric oral health services.

View the report here.

This study found that healthcare caseload for children enrolled in Medicaid varies substantially across different providers. Urban providers tended to experience higher caseload than suburban and rural providers, and there were notable trends in caseload between different provider types as well. 

View the study here.

This paper explored the downstream impacts of early dental intervention on state Medicaid expenditures. The Medicaid cost savings of the states studied from using topical fluoride and sealants before caries-related treatment ranged from $1.1 million to $12.9 million/year.

View the paper here

Dr. Jessica Meeske presented a pediatric dental perspective on value-based care at the Annual Symposium of the Medicaid, Medicare and CHIP State Dental Association Symposium on June 4, 2018, in Washington, D.C. The presentation was focused on identifying the value that Medicaid brings to her practice, why she sees Medicaid patients, and how dentists will react to a value-based system.

To view her presentation, click here.

This factsheet created by the American Dental Association includes infographics about child dental care during 2016, including a state-breakdown of changes in Medicaid and CHIP usage between 2011 and 2016, a comparison of private dental usage to Medicaid or CHIP usage between 2006 and 2016, and information about preventive dental visits.

View the factsheet here.

This technical brief presents the findings of a POHRPC research project on state Medicaid coverage of selected dental procedures by Erica Caffrey, DDS, MS, 2016-2017 Samuel D. Harris Fellow. Designed as a state-level advocacy resource, it identifies the pediatric dental procedures most essential for coverage, catalogs the coverage of these procedures by state, and specifies problem areas of coverage for oral health services. 

The table of codes covered by individual states was updated in 2019. 

Download Brief

This report discusses research on the relationship between reimbursement rates and access to dental care at the state level, given the dentist density and number of dentists participating in Medicaid per state.

View Report

This toolkit is an invaluable guide to getting a Medicaid program started in your practice. It features no-nonsense answers to common questions about how to appropriately administer Medicaid and offers a host of time-saving resources. 

Download Brief 

A helpful list of Medicaid informational resources compiled by the Centers for Medicare and Medicaid Services.

See Full List Here.

The Health Policy Institute of the ADA analyzed Medicaid fee-for-service (FFS) reimbursement rates among different states. They find that states with the lowest Medicaid FFS reimbursement tend to be the same for both adult and child dental care services. Nationally, there is sizeable variation between states in terms of both Medicaid FFS reimbursement rates as well as private dental insurance “discount” rates. 

View rate report.

AAPD member Dr. Jessica Meeske authored an editorial, "How Medicaid Audits Hurt Children In My Home State," published recently in The Hill.

In the op-ed, Dr. Meeske shares her experience with the Recovery Audit Contractor (RAC) program and concludes that it prevents low-income families and children from receiving dental care through Medicaid in Nebraska. She also notes that provider manuals in Nebraska give dentists discretion to determine frequency of treatment. Additionally, Dr. Meeske discusses how low-income patients, particularly children, are at higher risk and may need care more often than every six months.

To read the full op-ed, please click here.

More than 8 in 10 children enrolled in CHIP had a preventive dental visit in the past year, according to a July article for the Georgetown University Center for Children and Families. Based on an analysis of data from a 2012 survey of parents of CHIP enrollees in 10 states, CHIP-enrolled children were more likely to have a dental home and dental coverage than children enrolled in private insurance.

Read the full article.

The ADA has developed a toolkit designed to assist state dental associations in working with state Medicaid administrators in incorporating key elements into state Medicaid Managed Care Request for Proposals (RFP), contract specifications, and other contracts between state Medicaid Programs and other dental stakeholders.

View AAPD toolkit here.

Due to the Affordable Care Act, the Medicaid market for dental care will grow significantly in many states, even those electing not to expand Medicaid eligibility. This research measures the growth in the Medicaid market by comparing the potential increase in the number of adults and children with Medicaid dental benefits to pre-Medicaid expansion levels in select states. According to the report, the average increase in the potential number of children gaining dental benefits through Medicaid across all 50 states and the District of Columbia is 15.9 percent, ranging from 3.7 percent in D.C. to 40.6 percent in Nevada.

Download the report.

This research brief calculates Medicaid fee-for-service (FFS) reimbursement rates for dental care services relative to typical commercial dental insurance charges, and analyzes the changes in pediatric Medicaid FFS reimbursement between 2003 and 2013 in all states and the District of Columbia. In 2013, the average Medicaid FFS reimbursement rate was 49 percent of commercial dental insurance charges for pediatric dental services. From 2003 to 2013, Medicaid FFS reimbursement relative to commercial dental insurance charges fell in 39 states, and rose in 7 states and the District of Columbia. The available evidence strongly suggests that increasing Medicaid reimbursement rates for dental care services, in conjunction with other reforms, increases provider participation and access to dental care for Medicaid enrollees.

Download the report.

This brief discusses the impact of Medicaid reforms on access to dental care among Medicaid-eligible children, particularly the increases in Medicaid dental fees in Connecticut, Maryland, and Texas. Based on data from the 2007 and 2011–2012 National Survey of Children’s Health, preventive dental care utilization increased among Medicaid-eligible children in Connecticut and Texas compared to Medicaid-ineligible children and all children from a group of control states. In addition, unmet dental need declined among Medicaid-eligible children in Texas. The research suggests that increasing Medicaid dental fees closer to private insurance fee levels has a significant impact on dental care utilization and unmet dental need among Medicaid-eligible children.

Download the report.

Dr. Paul Casamassimo provided a Second Opinion addressing the ongoing financial and cultural challenges associated with Medicaid as it relates to the implementation of the Affordable Care Act (ACA). According to Casamassimo, "Often, criticism is exchanged between the dental profession and child advocates about Medicaid reimbursement and dentists' willingness to care for Medicaid-supported children at reimbursements well below their typical fees. However, the reality of the inadequacy of Medicaid reimbursement as it relates to safety-net dental programs caring for the poor brings this inequity into clearer focus. Today, across the U.S., safety-net dental programs are failing or at risk because the cost of providing dental care has increased while Medicaid reimbursement has not."

Read the article.

In Connecticut, similar to many other states, children on Medicaid could not easily access dental health services. Few dentists participated in the program with many providers citing low reimbursement rates and cumbersome program administration. Based on a 2008 lawsuit settlement agreement, program administration improved and reimbursement rates increased, moving closer to private insurance rates. A project funded by the Connecticut Health Foundation examined Medicaid data between 2006 and 2011 to determine the effect of the increased Medicaid reimbursement on access to care and provider participation. The findings showed strong increased participation by private providers and a resulting increase in care for children on Medicaid. 

Read the full report.

This online Medicaid Provider Reference Guide, developed in consultation with the AAPD,  offers exceptional resources for oral health professionals looking to better serve their communities, whether it is from a private practice or public dental safety net venue. 

View the reference guide.

The AAPD and CMS have partnered to provide members with webinars that provide a comprehensive overview of Medicaid program integrity, common compliance vulnerabilities, and benefits derived from developing or improving upon a compliance program. The AAPD has also worked closely with CMS and the ADA on compliance issues to help ensure that provider audits are fair and reasonable. CMS has now created an informative website on CMS Medicaid Program Integrity. The site provides educational resources for providers, beneficiaries, managed care plans, and other stakeholders, and promotes best practices and awareness of Medicaid fraud, waste, and abuse.

Follow this link to learn more about the website.