Medicaid Provider Information

MESSAGE from the Office of the NDA President

Dear NDA Member:

In recent months, we have received reports about Medicaid children being confronted with new barriers that are impeding their access to dental care. Although Early, Periodic Screening, Diagnosis and Treatment (EPSDT) is mandated by Federal law, many children are not receiving dental care, because dental providers are being dropped from state Medicaid rosters at alarming rates. In some cases, after decades of impeccable care and unblemished records, these providers have received notification that their dental Medicaid credentials will not be re-instated.

For over a century, NDA members have provided the safety net, and formed the backbone of the infrastructure in communities where their counterparts had no interest. Our members established their practices in communities where there was the greatest need. And now, a very disturbing trend is occurring in many states where existing programs for children are being systematically dismantled. Although Federal law mandates dental coverage for children under Medicaid, in some states, not only are Medicaid eligible children, and those eligible for care through SCHIP not being treated, those that already have dental homes are being displaced. Children and their families are being told they can no longer see their family dentist, and are being reassigned to new providers sometimes many, many miles away. Transportation is a barrier to access. Providers who have treated Medicaid patients for decades are being terminated by third party payers and dropped from the Medicaid provider rolls. So, the lack of available providers in vulnerable communities is also a barrier to access.

In effect, children and their families are being evicted from their dental homes. This epidemic is spreading as more and more children are being disenfranchised and access to dental care is being eliminated. Trusted relationships established between patients and their neighborhood dental homes are being eroded.

The National Dental Association is the voice of the underserved and supports its members in serving in communities where they are needed most. We are alarmed at what members are reporting:

  • In TN, 200 dentists have been “dropped” from the Medicaid provider rolls since December. And in one instance, thousands of children, as well as a large constituent of mentally challenged and disabled patients are left with no place to go. Patients received letters stating that they could no longer see their dentist, because their dentist could no longer work with a “particular managed care organization”. This decision appears to be based on “over-utilization” of services, as if optimization of access and optimal utilization of the Medicaid services by Medicaid recipients was a “bad thing”. Now, dental businesses that were part of the community’s health infrastructure, and practitioners that formed the safety net are in peril. Several are on the verge of collapse; and some have already been forced to close their doors.
  • In FL, where dental Medicaid providers receive a reimbursement rate that is 20% of their usual fee, treating Medicaid patients is considered to be their “charity work”. There are reports that patients who live in the same neighborhood as their “dental homes” have received letters informing them that they have been reassigned (akin to redistricting and gerrymandering) to a new dentist several miles away. There is no public transportation to take them to the new location; and when they call to see about getting an appointment, they are told the earliest available appointment for them is 6 months away.
  • In TX, dental Medicaid providers who practice in multiple locations have been told that they will only be credentialed to practice in one location. The processing time for dental Medicaid provider applicants has increased from a few weeks to a few months.
  • In MI, providers have seen a soaring increase in audits, and are questioning why long-term providers with pristine performance and record keeping, are now being scrutinized to the point of intimidation for no wrong-doing.
  • In DC, there are reports of excessive payment delays, up to five months to receive reimbursement for services.
  • Others report that they are reimbursed at lower rates depending on their zip codes.

These testimonials have only recently come to light; and for this reason, we will do our due diligence and get to the bottom of this. We are polling our members in ALL states to see if this trend is more wide-spread than originally believed. For the National Dental Association, access to health, health equity, and the safety and welfare of children are moral imperatives; and health equity for ALL is an issue of social justice.

We will keep you apprised of this alarming situation, and will seek your support as we endeavor to optimize access to dental care for Medicaid children and support dental Medicaid providers in meeting this need.

Sincerely yours,

Alison P. Riddle-Fletcher, D.D.S.
President
National Dental Association