April 07, 2020

Medicaid increases dental rates > New reimbursements will benefit children

Starting today, Maine dentists who agree to treat children in the Medicaid program will receive roughly twice as much money from the state for many common procedures.

The first increase in Medicaid dental reimbursement rates since 1988, the changes are expected to encourage more dentists to participate, increasing access for low-income children whose parents have been hard pressed in the past to find a dentist to treat them.

Between 80,000 and 90,000 Maine residents younger than 21 are entitled to Medicaid dental benefits, but at last count, only 250 dentists were accepting them as patients, said Maurice Gagnon, health planner for the state Bureau of Medical Services. Maine has about 950 licensed dentists, about 600 of whom are actively practicing.

When Gagnon looked more closely at the 250 participating dentists, he found that only a small proportion were very active in treating Medicaid patients.

“One of the really thought-provoking things we found was that a large portion of the providers were only billing once or twice a year,” Gagnon said. “We found that 80 percent of billings were coming from 15 or 20 percent of providers.”

Medicaid had 40 or 50 more dentists participating 10 years ago, said Jim Lewis, assistant director for the Bureau of Medical Services, the state agency that runs the federal Medicaid program in Maine. In recent years, it has become harder and harder for patients to find dental care under Medicaid. Those who did provide it piled up long waiting lists.

If the patient load stays the same, the additional cost of reimbursement will be $4 million. The state’s $1.5 million share will come from surplus in the budget, Gagnon said.

Officials hope more children will participate, which will cost more, but they say widespread regular check-ups will help prevent expensive dental crises. Medicaid offers only emergency dental care to adults.

The new rates are more than twice the old payments in some cases. In the past, a dentist would have received $19.75 for extracting a single tooth from a Medicaid patient. In 1998, Medicaid will pay $55 for the same service, matching the fee paid by Delta Dental, a private insurance company.

The state tried to match Delta’s payment rates for the most common services provided by Medicaid dentists. The program will now pay $13 for an oral exam, up from $7.75, and $43 instead of $21.50 for a panoramic X-ray, according to the Bureau of Medical Services.

Response from the state’s dentists has been positive. At least one, in Millinocket, has recently started advertising his new Medicaid-friendly status, said Lewis. A dentist in Pittsfield whose patient base is 60 percent Medicaid told the bureau the changes will allow him to stay in the program.

“Before, we were basically donating our time to see Medicaid patients,” said Ursula Hawkes, office manager for Bangor children’s dentist R.P. Nightingale. “Now it’s not so much of a donation.”

While some of the new rates jumped “into a reasonable range,” Hawkes said other procedures remain underpaid. Sealants are still a problem area, she said. Once funded at $9.25, Medicaid will now pay $16.

Dr. Nightingale, a specialist in more advanced dental problems, has accepted Medicaid patients in crisis even though, as Hawkes said, “there are only so many hours in the day.” She said the office is hopeful that more dentists will start offering primary care to the state’s poorest children.

“If they can get the preventive care they need, maybe they won’t need to see us as much for emergencies,” she said.

Though she is hopeful about improving access with the new reimburements, Rep. Elizabeth Mitchell, D-Portland, is one observer willing to express disappointment in dentists who have closed their doors to poor patients.

“It’s unfortunate that it’s come to this to get them to participate,” she said. “Doctors accept Medicaid payments. They don’t turn patients away. We found that one of the main reasons doctors do provide care is a sense of moral obligation, a sense of community. They take some pretty deep financial losses.”

Doctors are also underpaid by Medicaid and will receive a rate upgrade in 1998, said Gagnon. He pointed out that for general practitioners, office equipment and overhead is often less of a financial burden than for dentists.

Mitchell will introduce a bill in the Legislature early this year proposing a toll-free referral system to help Medicaid patients find dental care. Gagnon said a transportation system of vans and buses with volunteer drivers is available, though many people are not aware of it, and friends and family members can also be reimbursed directly for driving patients to see dentists.

He said a system is also in the works that would help remind families about appointments. Dentists have identified frequent no-shows as another problem with the Medicaid population.

“Dentists aren’t like doctors — they don’t have 30 people waiting. If they schedule 10 patients in a day and only six show up, their overhead’s the same,” said Gagnon. “I don’t think the Medicaid patients are worse than anyone else, but because the reimbursement’s so low it exacerbates the problem.”

To further pave the way for Medicaid participation, other changes effective today — approved after the required public hearing and public comment period — will allow dentists to use standard American Dental Association codes on billing forms instead of special Medicaid codes.

The Bureau will also arrange for periodic review of the reimbursement rates. “Obviously we don’t want to wait another 10 years and have the problem creep up on us again,” Gagnon said.

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