Louisiana Raised Medicaid Dental Fees, Now Significantly More Than Texas

Last July, Louisiana quietly and significantly increased its EPSDT Dental program fee schedule.

According to online information, the increase came about because Louisiana Medicaid was using the Full Medicaid Pricing program to establish fees. Its creator, the Centers for Medicaid and Medicare, ended this program.

So starting, July 1, 2023,  the state set the fee schedule based on their own Lousiana Medicaid fee schedule.

Louisiana Dental Association success

The Louisiana Dental Association was visibly pushing for this increased funding.  They wanted to see it kept in the state’s budget for 2023.  And indeed it was included in the Dental Managed Care Organization adjustment in the state’s budget legislation HB1 under state general funds. Louisiana legislators came through.

To promote the increase as needed and justified, the LDA noted that:

• Modest increases in dental Medicaid reimbursements in the early 2000’s were significantly offset by four rate reductions (one reversed) since 2008. Rates for EPSDT (i.e., under 21) average just over 50% of the 70th percentile of typical fees. Yet, dental office overhead averages approximately 64%.
• Rates for dentures, the only service covered for adults 21 and up, haven’t been increased in over 20 YEARS! Over the same period, what many labs charge the dentist to actually make the dentures has roughly doubled. Simply said, the Medicaid rate for dentures many times does not even cover the cost to the dental lab.
• Medicaid always needs more dentists, or at a minimum, to maintain the dentists we have now in the program and keep up with retirement of providers who participate in dental Medicaid. Expansion led to more adults seeking dentures, though few dentists can afford to provide that care for what Medicaid reimburses. And, some children eligible for Medicaid but not enrolled DID get enrolled when expansion brought in their parents. Total enrollment of kids in Medicaid is now 929,323, as of January 2023.

Old and new fee comparison

While the old and new fee schedules are below for perusal, the four main billing codes we compared show a 35% increase for each code.

Periodic Oral Examination – Patient of Record:
Code: D0120
May 2023 Fee: $27.24
July 2023 Fee: $36.88
Absolute Increase: $9.64
Percentage Increase: 35.39%

Comprehensive Oral Examination – New Patient:
Code: D0150
May 2023 Fee: $47.37
July 2023 Fee: $64.13
Absolute Increase: $16.76
Percentage Increase: 35.38%

Intraoral – Periapical First Radiographic Image:
Code: D0220
May 2023 Fee: $14.69
July 2023 Fee: $19.89
Absolute Increase: $5.20
Percentage Increase: 35.40%

Prophylaxis – Adult (12 through 20 years of age):
Code: D1110
May 2023 Fee: $48.01
July 2023 Fee: $65.00
Absolute Increase: $16.99
Percentage Increase: 35.39%

Comparison with Texas

When we compare the new Louisiana Medicaid dental fees to the current Texas fees, as represented by the TMHP THSteps non-facility fee, Texas comes off as bad—very bad indeed.

D0120 – Periodic Oral Examination – Patient of Record:
Louisiana Fee: $36.88
Texas Fee: $29.44
Absolute Difference: $36.88 – $29.44 = $7.44
Percentage Difference: ($7.44 / $29.44) * 100 ≈ 25.27%

D0150 – Comprehensive Oral Examination – New Patient:
Louisiana Fee: $64.13
Texas Fee: $36.04
Absolute Difference: $64.13 – $36.04 = $28.09
Percentage Difference: ($28.09 / $36.04) * 100 ≈ 77.96%

D0220 – Intraoral – Periapical First Radiographic Image:
Louisiana Fee: $19.89
Texas Fee: $12.56
Absolute Difference: $19.89 – $12.56 = $7.33
Percentage Difference: ($7.33 / $12.56) * 100 ≈ 58.39%

D1110 – Prophylaxis – Adult (12 through 20 years of age):
Louisiana Fee: $65.00
Texas Fee: $54.88
Absolute Difference: $65.00 – $54.88 = $10.12
Percentage Difference: ($10.12 / $54.88) * 100 ≈ 18.45%

Pretty incredible!

No results in Texas 

Latest Medicaid EnrollmentAccording to the Texas Dental Association, despite a record $32 billion surplus in the last legislative session, Texas legislators could not be moved to increase dental rates. In fact, the TDA reported in its October 2023 membership magazine that its efforts in the last legislative session not only failed but apparently had to protect dental fees from being cut despite there having been no increase in fees since 2007.

“Although TDA tirelessly advocated for a Medicaid dental fee increase, the legislature declined to support the initiative that would have resulted in an ongoing increase to the state’s budget. However, TDA did protect Medicaid and CHIP dental funding from budget cuts.

“TDA knows the vital role that Medicaid plays in Texas’ dental public health safety net. TDA will continue advocating for a fee increase that aligns with the program’s 2007 value when adjusted for inflation.”

Latest Medicaid enrollment figures

Yesterday, the latest enrollment figures for the state’s Medicaid unwinding came out. Almost one million children are still denied Medicaid for procedural reasons.

Sad situation all around.

LOUISIANA OLD FEES

LOUISIANA NEW FEES