The Effects of Medicaid Reimbursement Rates on Access to Dental Care

Dentists cite three primary reasons for their low participation in state Medicaid programs: low reimbursement rates, burdensome administrative requirements, and problematic patient behaviors. In the late 1990s and early 2000s, a number of states took dramatic steps to try to improve access to dental care in Medicaid. Alabama, Michigan, South Carolina, Tennessee, Virginia, and Washington employed a variety of approaches to address access concerns. They raised reimbursement rates, revamped administrative structures and processes, and conducted outreach and education to both providers and patients. This study, sponsored by the California HealthCare Foundation, focuses on the efforts of these six states and compares their experiences to California’s. The National Academy for State Health Policy (NASHP) conducted a literature review and 26 key informant interviews to answer the question: what effect does raising Medicaid reimbursement rates have on access to dental care? In the six states examined, provider participation increased by at least one- third, and sometimes more than doubled, following rate increases. The study found that rate increases that at least bring rates to a level where they meet the provider’s overhead expenses are necessary – but are not sufficient on their own – to improve access to dental care. Easing administrative processes and involving state dental societies and individual dentists as active partners in program improvement are also critical. Administrative streamlining and working closely with dentists can help maximize the benefit of smaller rate increases, and mitigate potential damage when state budgets contract.

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