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Action for Dental Health

Medicaid

Why We Need to Strengthen Medicaid Benefits

Medicaid dental program design challenges, excessive red tape and low reimbursement rates hamper access to dental care. Action for Dental Health’s solution is advocating for expanding Medicaid dental coverage and helping dentists and patients navigate administrative systems.

Although the Affordable Care Act has expanded the number of disadvantaged children with pediatric dental benefits, low-income adults still lack adequate access to dental care due to the non-existent or low level of dental benefits offered through Medicaid.

As of September 2015, 22 states did not provide any dental benefits to adults in their Medicaid programs beyond emergency procedures, and the average state allocates less than 2 percent of its Medicaid budget to dental services. This problem will only worsen as the insufficiently funded and cumbersome dental Medicaid programs are not capable of responding to increased demand for dental services from a growing Medicaid-eligible population, and should be improved to accommodate this increase in demand.

Excessive administrative burdens and reimbursement rates that are below the cost of providing care deter dentists from participating in Medicaid programs and there is a need to reverse this trend to ensure more dentists can provide care to more people in need.

  • In some states, such as Florida, paperwork for dentists to obtain Medicaid credentials can take up to 12 months
  • In a 2008 study conducted by the National Academy for State Health Policy, dental provider participation in Medicaid increased by at least one-third, and sometimes more than doubled, following reimbursement rate increases.

Our Priorities Are:

  • Maintaining the federal requirement for states to cover dental services under the Medicaid Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program.
  • Requiring states to cover dental services for Medicaid-eligible adults, and exempt all preventive dental services from cost-sharing requirements.
  • Preserving the federal financing role in the Medicaid program and update the federal matching formula to address economic changes.
  • Enhancing the federal Medicaid matching rate to 90/10 for dental care.
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