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, provider participation and patient access.
North Carolina to increase Medicaid fees
In North Carolina, Republican representatives Brian Biggs, the house deputy majority whip, Donny Lambeth, Larry Potts, and Tricia Cotham introduced House Bill 60, which aims to significantly boost Medicaid reimbursement rates for dental services. A further 50 House Representatives have jumped on the bandwagon to co-sponsor the bill.
House Bill 60 is designed to attract more dentists into the Medicaid network by aligning payments with current market standards. This proactive approach is a direct response to chronic provider shortages and limited access to dental care, particularly impacting children and underserved communities.
The bill states:
Whereas, good oral health is vital to good overall health, and untreated oral health conditions negatively affect overall health and have associations with chronic disease, including diabetes, heart disease, kidney disease, Alzheimer’s disease, and even mental illness; and
Whereas, the failure to adjust reimbursement rates to account for increasing inflation and costs over the last fifteen years has resulted in reduced dental provider participation in Medicaid; and
Whereas, regular preventative dental care is the most cost effective method available to prevent minor oral conditions from developing into more complex oral and physical health conditions that would eventually require emergency and palliative care; and
Whereas, in order to improve overall health and access to quality care, increase provider participation in Medicaid, and prevent future health conditions caused by overall health problems, it is in the best interest of the State to raise Medicaid reimbursement rates paid to dental care providers from 35% to 46% of the average dentist charges in 2023 in order to provide rates that are comparable with the Medicaid rates of surrounding states.
North Dakota to expand dental Medicaid
Similarly, in North Dakota, both the House and the Senate have introduced legislation with bipartisan support.
According to the North Dakota Monitor, “House Bill 1567 would fund a study of the dental health care status among Medicaid recipients and look at ways to recruit dental care providers to improve access for low-income children, Native American children and people with disabilities. Senate Bill 2231 would add dental coverage to Medicaid Expansion, the health insurance program for adults who aren’t eligible for Medicaid but whose household incomes fall below 138% of the federal poverty line.”
These efforts in North Dakota and North Carolina offer a timely blueprint for Texas, which is grappling with similar challenges but on a larger scale.
Texas dental Medicaid providers need assistance
As TDMR has continually reported, Texas Medicaid dentists face the rising costs of running dental practices, including staffing problems and inflated supply prices exacerbated by reimbursement rates that have lagged behind inflation.
Texas must consider significant fee increases similar to those proposed in other states to maintain quality care, attract skilled dental professionals, and ensure sustainability. Without such adjustments, the state risks further exacerbating provider shortages and undermining public health outcomes.