The National Conference of State Legislatures (NCSL) has published an online article that promotes the need for oral health for all citizens and highlights the strides some states have taken to improve access to dental care, including Medicaid.
The article states: “Several states have sought to reduce the number of people without dental coverage by modifying their state’s Medicaid eligibility requirements. For example, New York and Utah authorized their states’ Medicaid plans to include dental care for all residents up to 250% of the federal poverty line. Previously, New York’s free dental care program was limited to residents below 138% of the federal poverty line threshold, and Utah’s program was limited to specific residents and program enrollees.
Importantly, NCSL recognizes that low reimbursement rates affect provider participation in Medicaid
“While 47 states provide some dental benefits for adults enrolled in Medicaid, provider participation in Medicaid remains a barrier to accessing oral health services. About 33% of providers accept Medicaid, and low reimbursement rates are cited as one barrier for providers to accept patients enrolled in Medicaid. Some research suggests increasing reimbursement rates is one way to boost provider participation. In 2023, Nebraska passed legislation to increase the Medicaid dental reimbursement rate by 25%.”
It is also supportive of dental loss ratios for insurance carriers.
“Several states are exploring payor efficiency in oral health costs with dental loss ratios. These ratios refer to the proportion of the insurance premium revenue spent on patient care instead of operating costs. Some states are setting a minimum ratio that dental plans must meet, with a corresponding rebate requirement for plans spending less than that minimum. In other words, insurers that do not meet the minimum dental loss ratio may be required to make up the difference through rebates issued to patients. Rhode Island requires dental insurers to spend at least 85% of premiums on patient care. In 2024, similar bills were also introduced in at least nine states.
“Lastly, insurers have been exerting control over price setting and billing decisions, which can contribute to high costs for patients. Tennessee prohibits insurance carriers from dictating pricing to dentists for non-covered services and allowing dentists to accept multiple payment options.”
Regarding shortages of dental professionals, the NCSL article highlights the initiatives of several states.
“Several states are pursuing strategies to increase the number of oral health professionals. For example, Wisconsin is using state funds to expand dental programs at technical colleges to train more dental hygienists, dental assistants and dental therapists. Tennessee is increasing the number of dental hygienists who can be supervised by a dentist in public health settings, which may increase the volume of dental hygienists working in community settings.
“Dentists have some of the highest student loan debts among major health professionals, averaging about $300,000, which may deter the oral health workforce from practicing in under-resourced areas, further exacerbating workforce shortages in certain areas. Some states are incentivizing new dental providers to enroll in Medicaid and serve these under-resourced areas. Nebraska offers loan repayments up to a full year of tuition for each year of service for new dentists serving patients with Medicaid in designated shortage areas.
“Interstate compacts, which permit dental professionals to practice in jurisdictions outside their state of licensure, are another strategy to support the oral health workforce. Before Minnesota, Tennessee and Wisconsin recently joined the Dentist and Dental Hygienist Compact, dentists were largely limited to practicing in the state they were licensed. The compact facilitates multistate practice, reduces administrative burdens, expands access to qualified professionals and increases employment opportunities to new markets.
Lastly, the article promotes the increase in the use of teledentistry to bring care to underserved areas.
“Teledentistry is another policy option that can be especially effective in health professional shortage areas. Teledentistry allows patients to receive consultations, assessments and even some treatments remotely, reducing the need for in-person visits. Virtual access to dental care has been shown to enhance access by minimizing the need to travel long distances. Encouraging readily accessible dental services can facilitate early intervention and preventive care, helping address oral health issues before they progress into more serious conditions. At least 23 states allow teledentistry, and in recent years, Alabama and Illinois passed legislation providing guidelines for licensed dentists to use the services.”
It would be a good thing to see Texas highlighted as a leader in legislative efforts to promote dental care.