UPDATE: The Texas HHS Open Records Office sent TDMR a further document that contains only the active number of dentists in the Texas Medicaid program from 1996 to 2022. The previous document used contained both active and inactive combined. This article has been updated to utilize this data.
TDMR received the latest figures on THSteps Enrolled Dental Providers from an open records request filed with Texas Health and Human Services. The initial report was both active and inactive providers lumped together but the further report contained only active providers.
Dental provider enrollment since 1996
The report provides historical data on quarterly and annual dental provider enrollment from 1996 when the Frew case consent decree came into force. The report breaks down participation into low-volume, mid-volume and high-volume providers. A low-volume provider serves less than 30 Medicaid patients, mid-volume 30 to 99, and high volume over 100.
It is a historical fact that back in 1996 26% of active Medicaid dental providers were low-volume providers. This percentage has dwindled to 17% and 18% in the last few years, with high-volume providers picking up the slack.
In 1996, Texas Medicaid had 1,921 active dental providers. This number dwindled to 1,592 in 2002 and back to 1,743 in 2006.
2007 fee increase boosted the number of Medicaid dentists
In late 2007 the Frew Expenditure Plan was proposed and dental fees were substantially increased.
The number of active Medicaid dentists then rose every year from 1,779 in 2007 to a high of 4,156 in 2019.
Active dental providers from 2019 to 2021 roller-coastering
However, between 2019 and 2021, active provider totals have become stagnant, dropping in 2020 to 3,982 but going back up to 4,140 in 2021.
While quarterly figures are given for 2022, the final annual total will not be available until April 2023. As quarterly figures generally do not represent the final totals in any year, it is difficult to predict the final figure for 2022.
But clearly, 2022 quarterly active dental numbers do not show any great increase and possibly a drop in the number.
Inflation, staff problems exacerbate situation
With inflation and the difficulty in finding and keeping staff over the last year, coupled with a dental fee schedule that has only been reduced by 2% since 2007, it would not be surprising if this trend does continue, especially for low-volume providers. We've already reported on this.
Medicaid enrollment increased by 26.4%
During this same period of the pandemic, child enrollment in Texas Medicaid increased by 26.4%, according to a just published online article. You can't do more with less.
In the previous iteration of this article, we stated that "some 7,000 dentists treating 4.2 million children?" Well, it is worse than that. There is only about 4,000 dentists available to treat some 4.2 million children. 100,000 kids for every active dentist. Can't be done, can it?
Fixing the fee schedule
Fixing the dental fee schedule would certainly be a step in the right direction to increase provider enrollment. It only makes sense that low-volume providers would drop Medicaid patients when they can replace them with higher-paying clientele. Even private dentist are increasing their rates to cope with inflation.
With the state's budget surplus, we hope the legislature will make this a reality as other states have done.
The fact that fees have not been increased since 2007 is mind boggling. It’s not surprising that so many offices are closing with rising costs, staffing issues, and no change with fees as everything else is increasing in cost. This is a huge disservice to patients especially with the fact that enrollment has risen. Like the author said you can’t do more with less and at the end of the day the dentists suffer as well as the patient with a lack of practitioners if this trend continues
By fixing the fee schedule and increasing Medicaid reimbursement rates for dental care providers, Texas could make it more financially feasible for dentists to participate in the Medicaid program. This could, in turn, increase access to dental care for children enrolled in Medicaid and improve the quality of care available to them. shortage of Medicaid dentists can put additional strain on the remaining dental care providers, potentially resulting in lower quality of care due to increased patient loads.
It is remarkable that the fees have remained unchanged since 2007. Providers are faced with punishing operating costs and staffing issues due to continued rising inflation. Consequently, many offices are forced to close due to financial constraints, which is a great disservice to patients, especially given the significant rise in Medicaid enrollment. There are certainly not enough dentists enrolled to serve the size of the patient population that exists in 2023.
In order to address this, Texas should consider increasing Medicaid reimbursement rates for dental care providers. This could create a more viable financial situation for dentists to participate in the Medicaid program, thus increasing access to dental care for children enrolled in Medicaid. Moreover, it would reduce the strain on existing dental care providers, thus minimizing potential decreases in quality of care due to a very significant and sustained influx of patients.
The low reimbursement is only one of the reasons I dropped Medicaid. The main reason is the fight that it is to get paid these low fees. It was not worth my staffs time to argue to get paid. It put me over the top that procedures would get preauthorized and then they would still not pay. Unacceptable. I feel bad for leaving my patients but am tired of being abused by the system.
The real tragedy is that the children who need help the most will not receive the healthcare they most desperately need. The Texas leaders keep bragging about how great the economy is here and how much money Texas has. Somehow that money can’t find its way to our schools and healthcare facilities. Both of which are ranked at the bottom in terms of outcomes and quality.
I could find no oral surgeon for my adult disabled son who is a SSI-Medicaid Enrollee in the Texas Star Plus plan manged by UHC for 5 months he’s currently a Home Based and Community Services recipient. I tried for months with member services, service coordinators and the dental plan department who repeatedly said he needed a “waiver,” nothing was done he had all four wisdom teeth that had erupted and two were embed into his jaw resulting in two ED trips and antibiotics treatments. The kept referring us to General Dentist who told me to take him to the ER or Children’s Hospital, he’s 27. Finally I had to secure a stand alone commercial dentist plan, which became the primary and Medicaid secondary insurer to find an Oral Surgeon because the MCO stated the next available Oral Surgeon would be flying in a few months from California. The Oral Surgeon in -network for the stand-alone plan saw us within days and the extraction occurred in a week’s time including the administration of sedation. I had to pay $1250 out-of-pocket, Medicaid paid nothing and the Oral Surgeon said Medicaid always denied their claims, I had no choice. I tried to appeal with UHC that ran 7 months with no investigation results and no refund, just about 7-8 letters stating they were investigating! Texas has laws that state Medicaid recipients can get emergency care even if not a benefit or in-network if life threatening.
Texas Medicaid and most certainly the Dental care provided is a disgrace! But Texas who is broke or mismanaged won’t expand Medicaid. Thus the reason for the changes in leadership for Medicaid and Dental at HHSC!