A Medicaid dental provider with multiple offices in the state contacted TDMR this past week, voicing serious concerns about recent restrictions imposed on their practice by Canadian-owned DMO DentaQuest regarding the use of substitute dentists. Violation of Texas Administrative Code … Read More
Recent legislative actions in North Dakota and North Carolina—both Republican-led states—highlight growing nationwide recognition of the urgent need for Medicaid dental reforms. These developments underscore a critical issue facing Texas: inadequate dental Medicaid reimbursement rates, which continue to hinder staffing, … Read More
TDMR was contacted a few days ago by a concerned dentist who was unaware of which Medicaid reimbursement rates were changing as part of the upcoming March 1, 2025, fee adjustments. These rolled out as a result of the biennial … Read More
Despite all the talk of cost cutting in Tooth Fairy Land and despite curtailing payouts in other parts of the country, the Tooth Fairy continues to leave generous payouts for childrens’ lost teeth in Texas and the South. This unexpected … Read More
According to the latest online Health Resources & Services Administration statistics, Texas ranks behind California, Arkansas, Missouri, and Florida as the states with the most dental health professional shortage areas (DHPSAs). Texas currently has 265 areas designated as such. The HRSA … Read More
And the story rolls on. The Delaware Supreme Court this week ruled against insurance giants AIG, ACE, and Lexington Insurance, upholding a lower court’s decision to order a new trial in their dispute with Conduent State Healthcare (ACS/Xerox/Conduent) over coverage … Read More
A January 2025 oral health survey conducted and published by personal finance website WalletHub has ranked Texas as one of the states (the District of Columbia was included in the survey) with the worst oral health in the country. Source: … Read More
Texas is grappling with a critical shortage of healthcare workers, including dental professionals, exacerbating dental access and provider issues across the state. A recent Newsweek article, “How Texas Could Solve Its Health Care Worker Crisis,” highlighted these problems, mentioning a Becker’s … Read More
TDMR received this story from Dr. Hector Alvarez in Eagle Pass earlier this month. We found it informative and inspiring in his and his family’s dedication to helping the underserved and needy in his county. It speaks to the quality … Read More
According to a news item on the Husch Blackwell website, Texas filed suit against the federal government on December 11 to stop the recoupment of $83 million in Medicaid payments given to hospitals several years ago. The issue revolves around … Read More
The Texas Health and Human Services Commission (HHSC) plans to request $300 million from the state legislature to address extensive delays in processing Medicaid applications. This funding would facilitate hiring over 1,000 new employees and modernizing the outdated and heavily … Read More
In the Texas Health and Human Services Commission (HHSC) hearing held on November 12 about the proposed rate changes to the Medicaid dental fee schedule, eleven dental professionals, including a representative of the Texas Dental Association, testified, either in person … Read More
ACS State Healthcare and Conduent State Healthcare LLC have filed an appeal with the Texas Supreme Court, hoping to prevent a trial in which it must defend its flawed Medicaid prior authorization process, which rubber-stamped hundreds of millions of dollars … Read More
While DentaQuest limits its Medicaid network in Texas and threatens to boot over 100 providers from its network in urban areas, yesterday, its Canadian parent company, Sun Life Financial Inc., crowed about its share price reaching an all-time high, boosted … Read More
California has problems. We all know about them. Now, they’ve added DentaQuest as another one for their Medicaid (Medi-Cal) program to the apparent detriment of state dental providers, considering the company’s situation in Texas, Louisiana and other states. This past … Read More
TDMR has received a missive from a concerned dentist, which we are publishing. It sums up the frustration and intense concern about DentaQuest’s recent actions in limiting its network, including a threat to remove over 100 urban providers. This prodigious … Read More
It is a common misconception that your voice does not matter in big government. Unfortunately, it is that misconception that allows big governments to continue in a state of blissful unawareness about the need for change in their policies and … Read More
In our last article regarding the HHSC Provider Finance department biennial review of Medicaid dental fees, we published a letter sent to HHSC by a dentist to complain about the lack of real increase in rates made. Hot issue We … Read More
Texas Health and Human Services Provider Finance quietly posted its much anticipated legislated biennial review of Medicaid dental fees early last week. Well, maybe it was earlier, but it was only noticed early last week. It was found tucked into … Read More
Our story on foreign-owned DentaQuest’s limitations on dental care access for Medicaid children in Texas has sparked outrage among dental providers, leading to an outpouring of angry comments. Many practitioners shared their frustrations and experiences, highlighting how the restrictive policies … Read More
In a stunning move last week, DMO DentaQuest sent out a letter (copy below) to its Medicaid provider network that as of October 15, it would “be limiting the number of additional” general and pediatric dentists into its network in … Read More
The Sunshine State now joins the growing list of states that have recently increased dental Medicaid rates. Florida’s commitment to “live healthy” for its citizens On October 1, several health care bills came into effect in Flordia called the ‘Live … Read More
REPUBLISHED FROM THE TEXAS TRIBUNE Texas officials acknowledged some errors after they stripped Medicaid coverage from more than 2 million people, most of them children. A ProPublica and Texas Tribune review of records shows that these mistakes and others were … Read More
TDMR is pleased to announce that we received confirmation today from Texas Health and Human Services that, as of yesterday, DentaQuest is no longer paying a one-surface fee for non-interproximal two-surface fillings and will be reprocessing previously denied claims. Win … Read More
It’s a bad week for DentaQuest. Yesterday, according to an article in the online publication The Center Square, Louisiana legislators ripped into DentaQuest at a hearing of the House Joint Budget Committee as the Louisiana Department of Health had recommended … Read More
Remember we wrote that Texas should beware of DentaQuest and its corporate behavior, which cost the company $11 million in fines in Louisiana for Medicaid contract violations, which was recently cited in a report by the Louisiana Legislative Auditor’s office. … Read More
A recent article published by Becker’s Dental Review using Department of Labor statistics revealed that Texas ranks at the bottom when it comes to the number of dental hygienists per capita in the country. New Hampshire ranks number one with … Read More
In July, the Louisiana Legislative Auditor’s office published a scathing audit review of DentaQuest’s performance as one of the two dental maintenance organizations with Louisiana Medicaid. It fined the company for its poor performance. FYI, Louisiana calls them dental benefit … Read More
This week, a federal judge in Tennessee found that an algorithmic system similar to the one in Texas and designed by the same company illegally denied Medicaid benefits to thousands of Medicaid-eligible individuals. The TennCare Connect system, developed by Deloitte, … Read More
Justice for Medicaid dentists and orthodontists, whose lives, reputations, and practices were ruined in the great Texas Ortho Debacle, appears to be coming—slowly, but surely. Legal losses continue to mount for Conduent State Healthcare LLC, spun off from Xerox in … Read More
More comments have poured in as a result of our last article containing remarks from dentists about the state of their Medicaid practices. Medicaid dentists are having difficulty grappling with the crushing weight of rising costs and woefully inadequate Medicaid … Read More
TDMR’s recent article on the financial challenges facing Medicaid dental practices in Texas has struck a chord with a number of providers who left comments. We don’t often receive a spate of comments after an article, but this one certainly … Read More
The Texas Medicaid dental landscape faces a dire financial paradox. While costs for essential supplies, staffing, and real estate have surged dramatically, Medicaid reimbursement rates have stagnated below 2007 levels. Dental supply costs have increased by up to 98%, staffing … Read More
The American Dental Association’s Health Policy Institute (ADA HPI) recently published its “Economic Outlook and Emerging Issues in Dentistry” report for the second quarter of 2024. This comprehensive survey offers valuable insights into the current economic conditions, staffing challenges, and … Read More
The Texas Tribune published a major story yesterday about the problems Texas and other states are having with Medicaid eligibility systems developed by global consulting firm Deloitte. The Kaiser Family Foundation researched and wrote the story. A few sentences summarize … Read More
In what can only be described as a bombshell decision, the Texas Supreme Court has sided with Dr. Richard Malouf and his legal team. The Court not only reversed the $16 million summary judgment against Dr. Malouf but granted his … Read More
This week, several media outlets, including KXAN, have reported on U.S. Rep. Lloyd Doggett‘s release of correspondence from the Centers for Medicaid and CHIP Services (CMS) to Texas regarding significant delays and backlogs in processing Medicaid program eligibility. These delays … Read More
A few weeks ago, it was announced that Benecare Dental Plans has taken over the contract as a third-party payer for the Medicaid program in Massachusetts under MassHealth. DentaQuest lost the contract, which it had held for at least a … Read More
According to our review of the annual third-party actuarial reports produced for Texas HHS Provider Finance, the Medicaid dental premium rate for dental maintenance organizations has dropped significantly since 2011. The proposed per-member, per-month capitation rate paid to the DMOs … Read More
In a surprising move, the Arkansas Department of Human Services (DHS) announced this week that it is ending its Medicaid managed care dental program and transitioning back to a fee-for-service model starting November 1, 2024. This move from contracting with … Read More
