Editorial: Now Is the Time to Invest in Dental Medicaid

Dental Medicaid

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Dr. John Gibbons

Editorial: Now Is the Time to Invest in Dental Medicaid

In an editorial originally published in the July 2018 issue of the WSDA News, Dr. John Gibbons stresses the need to better fund Washington's Dental Medicaid Program to meet the needs of low-income patients in our state.
It is no secret that Washington state’s Medicaid reimbursement rates are abysmal. According to a 2017 Health Policy Institute Report, Washington is one of three states with the lowest Medicaid reimbursement rates for both adult and child dental services among those that provide dental services to Medicaid-eligible patients via a fee-for-service model. 

It should come as no surprise that Washington’s Medicaid reimbursement rates cover only a small fraction of the cost for child and adult dental services, at 32.5 and 25.8 percent, respectively – again among the lowest in the nation. When comparing Washington’s Medicaid reimbursement rates relative to private dental insurance reimbursement rates, our state is also found at the bottom of the list.

However, despite our solid place at the wrong end of Medicaid reimbursement rates, our state continues to be a leader for children’s oral health. The 2015-16 Smile Survey revealed that there have been substantial decreases in untreated decay among preschoolers and third-graders, as well as a decay decrease among second- and third-graders in every major racial/ethnic group since 2005. Even more significant, we have a 56.4 percent statewide utilization of dental services among Medicaid-eligible children. That’s close to the utilization rate for private dental benefits in many states. 

This apparent contradiction poses an important question: How are we achieving these results with such an underfunded dental Medicaid program? The answer is clear: Dentists across the state are committed to providing optimal oral health care to all Washingtonians. Through innovative programs, such as the ABCD program, and the individual contributions of countless dentists who are dedicated to the communities they serve, we are providing care to the kids who need it most, despite meager reimbursement rates.

While we have been successful in treating our state’s Medicaid-eligible children, that success has not yet been translated to adult patients. As many will remember, the state cut most adult dental benefits during the depths of the recession in 2011 and did not restore those benefits until 2014, leaving our state’s dentists grappling to get a handle on the demand for dental care. 

Simply knowing that the adult dental benefit is subject to the chopping block anytime there is a state budget crisis leaves dentists and patients feeling unsettled. This is not a sustainable model, and a quick look at the state’s spending over the past few years shows that they continue to pay for costly extractions and dentures, many of which could have been avoided with more regular preventative care. This situation negates the original intent to save public dollars. As an old car repair commercial said, you can pay now or pay more later. 

Program instability and reimbursement rates that do not come close to covering costs aside, the administrative hoops dentists have to jump through and high no-show rates make treating this vulnerable population very challenging for many of us. 

For years, the WSDA has been advocating in Olympia for more money to be allocated toward the dental Medicaid program. In general, the response has been that the funding simply did not exist. However, today that clearly is not the case. With the McCleary education funding decision more or less behind us, a recent state GDP increase of 4.4 percent (the largest increase of any state), and significant increases in state revenues as a result of a burgeoning state economy ranked number one in the nation, it is time to have this conversation again. This time, under the premise that the funds do, in fact, exist.

With the upcoming transition to managed care, there are many unknowns about the future of our state’s dental Medicaid program. But one thing remains clear: Regardless of who administers the benefit and how much money they claim they can save the state, increased funding is still needed – and needed now – to meet the needs of low-income patients in our state. 

It is time to start making real investments in healthcare that focus on the whole person, and that includes the mouth. 
The views expressed in all WSDA publications are those of the individual authors and do not necessarily reflect the official positions or policies of the WSDA.

Medicaid Transition to Managed Care Cancelled

The 2019 Legislature has directed the Washington State Health Care Authority (HCA) to continue to administer the dental Medicaid program through fee-for-service. The HCA may not proceed with a carved-out or carved-in managed care dental option at this time.

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