The ADA Council on Advocacy for Access and Prevention seeks regular guidance and support from its Medicaid Provider Advisory Committee (MPAC). Chaired by Dr. Sidney Whitman since 2011, this committee offers tools for dental professionals who want to treat Medicaid-eligible patients. In addition, the ADA Health Policy Institute (HPI) offers webinars and white papers for professionals who want to learn more about Medicaid enrollment, outcomes and trends.
Participating in Medicaid
Medicaid and the dental care safety net
Dr. Howard Elson: Why I am a Medicaid provider
Medicaid Provider Reference Guide
Medicaid represents $1 out of every $6 spent on health care in the U.S. and is the primary source of funding for states to address the health needs of low-income residents.
Medicaid is jointly funded by states and the federal government. As the third largest domestic program in the federal budget — right behind Medicare and Social Security — the program plays a unique role in state budgets. As a result of this joint financing structure, Medicaid acts as both an expenditure and the largest source of federal revenue in state budgets.
States are required to balance their budgets on a regular basis, making choices about program spending and how much revenue to collect. Balancing these competing priorities creates an ever-present tension that ultimately affects Medicaid and CHIP.
- To assess and identify problems early
- To check children's health at periodic, age-appropriate intervals
- To provide screening tests to detect potential problems
- To perform diagnostic tests when risks are identified
- To control, correct or reduce health issues uncovered by testing
Here are helpful resources on children’s dental care from Medicaid.gov, the Centers for Medicare and Medicaid Services (CMS) and other organizations.
Some dental professionals provide care for large numbers of Medicaid-eligible adults. Others accept a modest number of these patients, encouraged by “Take Five” programs that have proven useful in several states.
Many dentists are reluctant to treat Medicaid patients, citing these concerns:
- Low reimbursement rates
- Administrative burdens
- Worries about complying with Medicaid regulations
- Perception that no-show rates will be high
- Lack of clear information about existing dental benefits
- Transportation challenges that patients may face
- Issues of cultural competency, including language barriers
- Need to educate this patient group about the benefits of regular oral care
Working alongside other stakeholders, the ADA is engaging state dental associations and Medicaid programs to address these concerns. For example, the ADA’s Council on Dental Benefit Programs has developed a sample template for working with states that contract with third-party administrators of managed care plans. By clearly stating expectations, responsibilities and risk-sharing, all parties know what to expect and who will be held accountable within the contract. This is critical, since Medicaid audits are becoming more frequent.
Several states have made real progress in convincing more dental providers to accept Medicaid patients, using incentives such as modest increases in reimbursement rates. Challenges and best practices are gathered and shared with other states to widen the dental safety net nationwide.
Dentists are well-trained to document the steps they take, but it’s equally important to establish medical necessity. This means confirming that the appropriate treatment and supplies were chosen in order to evaluate and treat a specific condition, illness or injury. Documentation should confirm the rationale for the procedure in alignment with the Current Dental Terminology (CDT) Code.
Depending on the situation, dentists may need to document that care was necessary to:
- Eliminate or prevent orofacial disease, infection or pain
- Restore form and function to dentition
- Correct facial disfigurement or dysfunction
Here are helpful resources on documentation and fraud awareness.
In working with Medicaid patients, you may encounter cultural or language barriers that make it difficult to provide the best possible care. Fortunately, there are resources that can help.
The Department of Health and Human Services Office of Minority Health (HHS OMH) has created a free online education program for oral health professionals. This program will help you build the knowledge, skills and awareness needed to care for all patients, whatever their background.
The course is designed for all dental professionals working with diverse populations. Those who complete the course can earn six CE credits.
Georgetown University also offers this resource:A guide to choosing and adapting culturally and linguistically competent health promotion materials
Self-direction of home and community-based services (HCBS) lets patients determine the mix of personal care services and supports that will work best for them. Many states that have implemented managed care programs are offering patients the opportunity to direct their own HCBS. Health plan case managers play a key role in implementing self-direction.
The Integrated Care Resource Center, with support from the former National Resource Center for Participant-Directed Services, has developed a training curriculum for case managers. The webinars and resources in this curriculum offer an overview of self-directed care, considerations for design and implementation of a self-directed program and best practices for self-directed programs in a managed care context.
Whether your state uses one third-party administrator or several, advocacy efforts can make a difference. Timely action can improve contract terms before new agreements are signed with administrators. This is true whether your state Medicaid plan handles dental benefits through a stand-alone contract or as part of a larger contract covering all health services.
The ADA has developed a toolkit to help state dental associations work with Medicaid program administrators. View the toolkit below, along with other related resources.
Many dentists use silver diamine fluoride (SDF) to treat carious lesions without the need to drill and fill. This strategy may be useful to you in caring for Medicaid-eligible patients. Here are relevant resources on SDF use.
ADA Public Practice Readiness Toolkit
The ADA Public Practice Readiness Toolkit is a comprehensive resource offered by the Medicaid Provider Advisory Committee (MPAC), part of the ADA Council on Advocacy for Access and Prevention. Whether you are caring for eligible patients in private practice or a public health setting, you will find helpful guidance here. Along with practical suggestions for serving clients covered by Medicaid, you will also discover opportunities to work in underserved areas where dental professionals are urgently needed. Many of these programs offer scholarship and loan repayment programs that can help cover the cost of your dental education.
Published by the National Maternal and Child Oral Health Resource Center, this helpful manual is for staff members working in safety-net dental clinics. It offers guidance on all aspects of clinic development and operations for clinic directors, new administrators and everyone in between.
The manual includes clear, actionable advice from a team of experts that understand the challenges of operating a public oral health clinic. Staff members will find practical advice for running their clinic in an efficient, effective, productive and profitable way while maintaining patient safety and quality care.
- View oral health as a key part of overall health
- Engage in recommended oral health practices
- Enjoy affordable, high-quality oral health services
Achieving this vision requires everyone to have access to care, regardless of income or geography. NNOHA offers a wealth of tools for safety-net dental professionals. These include:
- Operations manuals that cover health center fundamentals, leadership, financials, risk management, workforce and staffing, and quality
- A dental dashboard and user’s guide to support quality improvement in public dental settings, offering concrete measures, data collection tools and more.
- New perspectives on dental program management, so that oral health teams don’t have to reinvent the wheel but instead, can learn from peers working with underserved populations.
Visit the NNOHA website to view these and other resources.
Go to NNOHA.org
- Safety-net dental practice management online courses, providing 30- to 60-minute online learning modules for dental directors and dental practice managers. CE credits are available to those who complete the courses.
- Lunch-and-learn webinars highlighting best practices in safety-net dental practice management.
The Indian Health Service (IHS) Division of Oral health offers rewarding careers for dentists, hygienists and dental assistants who are ready to provide culturally competent care for American Indians and Alaska Natives.
As an IHS dental professional, you will have the opportunity to live and work in some of the most beautiful areas of the United States. With eligibility for the IHS Loan Repayment Program, your commitment to public dentistry could include financial assistance in paying down your dental education expenses. You’ll also enjoy competitive pay, bonuses, comprehensive health care coverage and opportunities for advancement. Along the way, you will be changing lives — possibly even your own.
Federally Qualified Health Centers (FQHCs) are community-based, patient-directed organizations that provide comprehensive, culturally competent health care services. These centers often include pharmacy, mental health, substance use disorder and oral health services all in one place — a real advantage for people living in areas where economic, geographic or cultural barriers make it difficult to access quality care.
FQHCs deliver care to the nation’s most vulnerable individuals and families, including veterans, agricultural workers, public housing residents and people experiencing homelessness.
To learn more about becoming a dental professional at a FQHC, visit the Health Services and Resources Administration website.Visit site
The National Health Service Corps (NHSC) builds healthy communities by supporting qualified health care providers dedicated to working in areas of the United States with limited access to care. The NHSC awards scholarships and loan repayment to primary care providers in eligible disciplines, including dentistry.
Since the NHSC began, more than 50,000 primary care medical, dental, and mental and behavioral health professionals have taken part. To learn more about career, scholarship and loan repayment opportunities, including a list of underserved areas in need of dentists, visit the NHSC website.