States experience Medicaid wins

Victories include reimbursement rate increases, centralized credentialing

A number of states have experienced Medicaid wins within the dental community over the past few months. From victories like reimbursement rate increases to centralized credentialing to removing annual dental services caps, here are the ways in which some states are making efforts to improve dental Medicaid. 

Georgia approved an $11 million increase in adult dental benefits for people enrolled in Medicaid. Last month Gov. Brian Kemp signed House Bill 916, the state’s appropriations bill for fiscal year 2025.

Nebraska passed Legislative Bill 358, which increases the reimbursement rate for dental services provided under Medicaid by 12.5% for fiscal year 2025. The bill was passed unanimously, 47-0, and took effect immediately. The state also removed a $750 annual cap on dental services for adults enrolled in Medicaid in an effort to improve dental care access and allow providers to offer more comprehensive treatment. 

Jessica Meeske, D.D.S., president of the Nebraska Dental Association, said while the organization originally asked for a 25% increase, the overarching goal was to find common ground. She added that many dentists, physicians, dental students and health departments testified at the hearing. 

“Nebraska is very fortunate to have worked with our governor’s office as well,” Dr. Meeske said. “His chief policy officer came out to my office and looked in the mouths of children with Medicaid to help better understand the need for care. While this was a big win for Nebraskans with Medicaid, now our work begins to encourage dentists to see patients with Medicaid so we can address our access to care issue.”

West Virginia’s House Bill 4993 takes an innovative approach to the state’s Medicaid dental coverage annual benefit limit of $1,000. The law doubles the term from one year to two resulting in a benefit of $2,000 maximum over a two-year term. This allows coverage for dental service costs that might exceed $1,000, and since the actual total limit was not raised, there is no additional cost to the state for the benefit.

West Virginia Dental Association Executive Director Hallie Mason said member dentists vocalized “great frustration” with the $1,000 cap. She noted West Virginia Medicaid pays $600 for an upper and lower denture, meaning patients are unable to receive a full denture in one year, as $1,200 exceeds the $1,000 limit. 

“West Virginia consistently ranks towards the bottom of most oral health rankings. The [West Virginia Dental Association] believes it is important to strategically improve access to dental care for our citizens and is grateful our elected officials were willing to help make this tweak to Medicaid law,” Ms. Mason said. 

Colorado allocated $78 million in the state budget toward Medicaid funding for fiscal year 2024-25. The funds will increase reimbursement rates for Medicaid dental providers, and according to Colorado Dental Association Vice President Jeff Lodl, D.D.S., was fueled by more than 18 months of work by the Colorado Dental Association Medicaid Task Force. This included a group of dentists who work to address challenges faced by Colorado Medicaid providers to “help make sure the Medicaid dental benefits continue to be a success.” 

The task force prioritized the most meaningful rates for patient care and provider recruitment and retention, and 28 codes were approved for rate increases: 15 preventive, periodontic and endodontic codes and 13 diagnostic and crown codes. 

“Sustainable provider reimbursement rates are critical to providing excellent patient care in the Medicaid program and to provider recruitment and retention,” said Dr. Lodl, who also chaired the Colorado Dental Association Medicaid Task Force. “The Colorado Dental Association will continue to work with the state legislature with the goal of raising all dental Medicaid reimbursement rates to align with benchmark data through the 2024 Medicaid Provider Rate Review Advisory Committee process.”

Ohio now mandates that all managed care plans use the Council for Affordable Quality Healthcare for credentialing. This will create single credentialing, which not only standardizes the process and documentation collection but also works to eliminate repetitive work, improve revenue cycle and lower credentialing costs for providers, practices, hospitals and facilities. 

Ohio Dental Association Executive Director David Owsiany said the Ohio Dental Association has been working with the Ohio Department of Medicaid for many years to improve the state’s Medicaid program, including during the re-procurement process with the Medicaid managed care plans. 

“The [Ohio Dental Association] is pleased that the department of Medicaid is requiring the use of a uniform credentialling process for providers within the Medicaid system across all of the Medicaid managed care plans. This will help ensure more prompt processing of credentialing applications and a uniform process across all entities involved in administering Medicaid dental benefits in Ohio,” Mr. Owsiany said. 

Additionally, Ohio’s fiscal year 2024 budget included a significant additional investment into dental Medicaid reimbursements. Effective earlier this year, dental reimbursements in the state’s Medicaid system increased by 93% on average per procedure. 
 
Missouri saw more than 100 new providers sign up to participate in Medicaid for 2024, after raising the reimbursement rates to 80% of the 50th percentile. This approximately 10% increase took decades of work with many oral health care stakeholders addressing the need to increase reimbursement rates for dental Medicaid, Missouri Dental Association Executive Director Vicki Wilbers said. The fiscal year 2025 budget also included $2.4 million towards additional coverage for dental anesthesia and extraction codes in parity with Medicare. 

An “essential part” of the successful increase came from hiring a dental Medicaid facilitator, according to Ms. Wilbers. The Missouri Foundation for Health provided a grant to the Missouri Coalition for Oral Health to hire the position in December 2022 to assist dentists in applying to be a provider, answer their questions and provide education through regular meetings. The facilitator works closely with the state Medicaid program, the Office of Dental Health and the Missouri Dental Association. 

“Missouri Medicaid rates are often higher than private carrier dental reimbursements. That makes this a good financial decision for many providers to join. And then on top of that, [with] the additional help with the facilitator, it results in the goal of all this: more oral health access for Missourians,” Wilbers said. 

Rhode Island passed Senate Bill 2751, which adjusts the Medicaid reimbursement rate for dental procedures performed in ambulatory surgical care centers by including a new dental rehabilitation code, called G0330, on the list of procedures eligible for Medicaid reimbursement. G0330 allows ambulatory surgical care centers to bill for facility costs they incur by making their facilities available for dental procedures. The legislation requires that services billed by ambulatory surgical care under G0330 are reimbursed at 95% of the total payment rate listed on the Medicare Part B Hospital Outpatient Prospective Payment System. 

Fred Hartman, D.M.D., past president of the Rhode Island Dental Association, said the “unimaginable wait” of 14 to 18 months for patients requiring dental care under general anesthesia prompted legislators to pass the bill.  

“The prior facility fee was too low for outpatient surgery centers and most hospitals to accommodate patients and their families without taking significant losses. The new fee is on par with commercial carriers and will open up much needed space in operating rooms for some of our most vulnerable patients,” Dr. Hartman said. “This bill's passage is significant because it provides immediate relief and is another indicator that legislators and the public understand oral health is deeply connected to overall health.”

Florida passed the Live Healthy Act earlier this year, which includes a $35-million fee increase for dental services in the state's Medicaid program. The program hadn't been updated since 2011. The law maximizes impact by requiring Medicaid managed care organizations to pass through the fee increase to dentists participating with Medicaid managed care organizations. 

"Oral health has far-reaching impacts on the overall health and well-being of Floridians. By supporting solutions that safeguard patients and promote access to routine dental services and preventive care for all Floridians, we can make a lasting impact on people's lives, health and futures," said Beatriz Terry, D.D.S., immediate past president of the Florida Dental Association.