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 or virtually. They all raised urgent concerns that the proposed fee changes were insufficient to help providers continue delivering high-quality care due to increased costs after rates have remained stagnant for over 17 years.
The nub of the matter is that less utilized codes were increased while heavily utilized codes were not. And D0145 gets a 62% drop from $142.07 to $54.58.
Providers financing the Medicaid program
As one provider put it, Medicaid dentists have not only been put in the position of compromising quality of care but of financing the state’s dental Medicaid program with their own resources.
Testimony probably a first
Such testimony is probably a first for the state. It is pretty much a certainty that this is the first time dental providers have appeared before an HHSC Provider Finance hearing. That so many took the time out of their busy schedules is testimony in itself of the need for a meaningful rate increase.
Hearing resources provided
TDMR has edited the hearing video available on the Provider Finance website to highlight the testimony of the dentists and uploaded it to our YouTube channel. We also have a machine transcription of the testimony, which is not perfect, that can be downloaded below.
TDMR also submitted comments to Provider Finance on November 12. A PDF of that is included below.
Quotes from testimony
Here are some meaningful quotes:
“The last fee increase we had was 2007… A dollar in 2007 is now $1.55 when you look at the inflation index as well.”
“We are losing skilled healthcare workers to fast food jobs. That’s what it’s come to where the rubber meets the road.”
“We’re unable to compete with Chick-fil-A and other businesses for [staff], and we’re unable to pay our staff the proper amounts.”
“We are seeing offices on the ground going out of business because they are no longer able to compete and maintain their business with the fees where they are.”
“We’ve seen a 25% exit of dental assisting staff and hygienists from dentistry, both in Texas and across the country.”
“Early intervention frequency and education with fluoride treatment work… There’s a 30% improvement in lifetime costs and outcomes for patients who receive early care.”
“Pediatric dentists report they are paying 20% more for the cost of supplies and labor than they were paying just five years ago.”
“Every day, our organization hears from frustrated providers who are debating the heartbreaking decision of leaving the Medicaid program.”
“We have endured an astonishing 17 years of zero increase in reimbursement rates.”
“A significant amount of my patients travel 150 to 200 miles to see me because there are no local providers willing or able to treat them.”
“Restorative treatment has become a huge burden… I’m getting paid in 2007 fees that are completely insufficient.”
“I’ve had to take on a second position outside my practice… essentially subsidizing the state’s healthcare costs by working for free.”
“TDA is advocating for a $250 million annual increase to restore Medicaid dental fees to 2007 levels, adjusted for inflation.”
“Meaningful reimbursement improvements require the Texas Legislature to increase funding for Medicaid dental services.”
“Low fees drive low quality. The lower the fees, the lower the standard of care.”
“We frequently do a lot of dental care… for which we do not get paid because of this inhibitory process.”
“Preventive care is important… Yet denial of claims or restrictions of service make it harder to deliver holistic, comprehensive care.”
“While we appreciate the move to make adjustments, the adjustment needs to be significant to actually match current market rates.”
“In 2007, Health and Human Services’ budget was around $210 billion. It’s now $320 billion… yet dental reimbursements have gone down.”
“You spend a dollar on prevention, you’re going to save $2 down the road in treatment.”
We sincerely hope these voices will be heard for the good of the Medicaid-eligible children in Texas.