Eight dentists and dental industry leaders shared with Becker's what they believe could be the possible impact of expanding Medicaid dental coverage for adults — both positive and negative.
Note: Responses were lightly edited for clarity and length
Question: With more and more states expanding dental coverage for adults through Medicaid, what is the potential impact that could have on the dental industry, good or bad?
Steven Appel, DDS. Owner of Appel Orthodontics (Philadelphia): Since the Medicaid component of our practice involves only orthodontics for teens, I can't comment specifically. However, any increased access to care is something I would imagine would be viewed favorably.
Shannon Enders. Founder of Lakeshore Employee Benefits (Norton Shores, Mich.): If a provider's payer mix deteriorates (Medicaid being the lowest paying payer), I assume dentists will try and make up the lost revenue elsewhere. This could lead to de-parring with commercial dental plans. In Michigan, we are seeing some dental offices dropping Delta Dental and BCBS and then balance billing their patients. Of course the letters from the dental office state that this will be good for the member, that the dental plan will still pay for covered services and that the dental office will still even help file the claims. No mention that the member will get balance billed, which is not good for the member. Another possibility is dentists don't bring on additional Medicaid patients.
It's fine with me if a dental office decides to no longer par with Delta, MetLife or whoever. Just be honest with your patients about the financial impact it will have on them come claim time.
Misako Hirota, DMD. Owner of Hirota Dental (National City, Calif.): The current Medicaid programs reimburse at a level that is unsustainable for most practices, which is the main reason that access to care is poor in most states. Provider numbers are insufficient due to the reimbursement rates and the difficulty in navigating the Medicaid claims process. State government seems to forget that dentistry is a small business model that cannot bear the burden of unreasonable reimbursement rates. Expansion will only exacerbate the number of patients unable to find care in a timely manner.
Huzefa Kapadia, DDS. Dentist at Detroit Sterling Dental: The good thing is that more patients get dental treatment they need quite badly, and I think overall impact will be good. However, as dentists who accept these programs, there are always strings attached when the government gets involved. Usually they will ask for money back in the form of audits. So that can be very stressful to go through, and disheartening.
Michael Perpich, DDS. Dentist at Northland Smiles (Deerwood, Minn.): I think it is long overdue to provide adults dental coverage through Medicaid. I think this will be good for the dental industry as long as additional funding is provided for this group and dental offices are reimbursed timely for services. If no additional funds are provided it will be more of the same, with many adults having nowhere to seek care because of low fees.
Peter Rivoli, DDS. Owner of Rivoli Dental (Avon, N.Y.): I ultimately believe it is a good thing for some patients, but for the profession I believe it still brings us down a path where the patient's expectations relative to the coverage can't be fully achieved without a supplemental payment plan. Here in New York the cap on payment is $1,000 per year, which may only accommodate partial payment for most large dental procedures. So, something is better than nothing, but my fear is that this is a slippery slope which may lead to future restrictions on procedure fees. In a long drawn out answer, I believe the long-term result will not benefit the growth of our industry but place it on a path to more regulated fees and/or no cost adjustments for inflationary pressures.
Charles Schlesinger, DDS. COO of Comfortable Dentistry 4U (Albuquerque, N.M.): Although it will be good to have more care available for the underserved patient population, the unfortunate reality is there will not be enough providers. The reason for this is that with the current, very low reimbursement rates, few dentists will want to be providers. In my current state of New Mexico, we already are seeing that without increasing the reimbursement numbers, it will definitely be the patients who will suffer with long lead times for appointments or no possibility of treatment in their region.
Angela Verma, DDS. Dentist at Angela Verma DDS (New York City): From a human and medical perspective, it sounds great. Patients who didn't have coverage or can't afford dental care often go to the dentist in emergencies. Typically these emergency situations lead to tooth loss or other extensive and expensive procedures that could have been treated in an earlier state or prevented altogether. From a business perspective, it all depends on Medicaid reimbursements to the providers. Medicaid has gotten quite complicated, and although I have not participated with Medicaid for over 10 years, typically in New York there is a different contract for hospital institutions and large federally qualified institutions. Their reimbursements from Medicaid can be very lucrative. For the same procedures, a different type of contract is given to private offices — one that is very low. These private provider contracts are so low that many offices would lose money if they participated in these plans and did the dentistry on these patients. As a result, most dentists try to stay clear of them altogether. If the goal is trying to increase access to care of patients on Medicaid, they would have to start reimbursing the dentists as your typical commercial insurance plan, or it would not make any sense for dentists to participate with Medicaid. Lastly, if Medicaid access is increasing, newer graduates may be encouraged to go into public and community service as opposed to the private sector.