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.
The should be requiring compliance with 42 USC 1396A 30(A).
This is the Federal ratemaking requirement for EPSDT.
This is what we are doing in Massachusetts.
Is there a way to take this to the press? Since it would require legislators to increase the budget, maybe there would be more pressure if a news station picks it up and publishes an article.
That is what we have been trying to do Ayham…what state are you in?
Texas
I have been a Medicaid provider in private practice for the last 18 years and since Covid and increases cost of goods it has been difficult to survive. I read the testimonies and I can agree with everything they are saying. I sincerely hope our voices are heard and changes are made. Each year I question how long can I survive.
We are having many issues with DentaQuest in New Mexico. They terminated many providers in New Mexico and do not enroll more providers.
I am not sure why the state or Dental Board is not reviewing the company’s business practices. This is also happening in other states. what can dentists do? It’s not right?
How can dentists voice their concerns or make improvements to this failing dental system?
Is New Mexico a Fee for Service Medicaid program (DQ merely moves payment from state to provider), or a Managed Care Medicaid Program (DentaQuest is paid for all services first, and then pays providers, and keeps whatever is not used for themselves? My guess is it is the latter – because eliminating providers helps them save money. This is something that should be brought to the members of teh Health Finance committee of your state. Additionally, you need to read this…it will explain an important law that would stop this from happening if your state forced compliance with it. https://dentalinsurancequality.org/how-a-child-medicaid-law-affects-all-dentists-and-patients/
Correct:
In New Mexico, DentaQuest has a Managed Care Medicaid Program (DentaQuest is paid for all services first, and then pays providers).
Thank you for providing the article.
I will send a complaint to the Attorney General’s Office and Health Finance Committee.
It’s a shame, that Medicaid patients no longer have access to adequate Dental care anymore in New Mexico and other states because of one company- DentaQuest.