Update on Adult, Pediatric Medicaid Reimbursement
Beginning July 1, 2025, reimbursement rates for both adult and pediatric dental Medicaid will decrease. This change is a result of budget cuts enacted by lawmakers during the 2025 legislative session.
WSDA members and staff invested significant time and resources this session into educating legislators about the negative health implications of cuts to dental Medicaid reimbursement rates. These efforts spanned a variety of advocacy tactics, including:
- Having direct conversations with lawmakers
- Engaging our members in grassroots advocacy campaigns to deliver this message to their legislators
- Teaming up with other oral health advocacy groups to reinforce the message
- Sending correspondence to House and Senate leadership, fiscal committee leaders and the full Legislature
- Delivering a veto request to Gov. Bob Ferguson
Regrettably, despite numerous, persistent advocacy efforts, lawmakers opted to reduce benefits for both adult and pediatric Medicaid patients. Varying levels of cuts were proposed at different points in the session. In the end, here’s how lawmakers chose to cut reimbursement rates:
Adult Dental Medicaid Reimbursement Reduction
- In 2021, the Legislature increased reimbursement rates for adult dental services by up to 100% of the rates that were in effect Jan. 1, 2019.
- This session, the Legislature lowered that previous increase from up to 100% to up to 50% of the rates that were in effect Jan. 1, 2019.
- It is our understanding that FQHC encounter rates will not be impacted by these reductions.
- These changes take effect on July 1, 2025.
Pediatric Dental Medicaid Reimbursement Reduction
- The 2022 supplemental budget increased Medicaid reimbursement rates for children's dental services.
- This session, as with the adult dental Medicaid rollback, lawmakers removed 50% of the increases implemented in 2022 for all procedure codes except those under the Access to Baby and Child Dentistry (ABCD) program.
- These changes take effect on July 1, 2025.
A draft fee schedule for the updated July 1 rates is available for download here from the Washington State Health Care Authority (HCA). Please note that this draft is subject to change.
WSDA believes these significant cuts are sure to compromise the health and well-being of some of our state’s most vulnerable children and adult patients. They will also increase future dental treatment costs, creating significant future budget repercussions for the state.
Given the national-level conversations on reducing Medicaid rates, this is an issue we must continue to address with our elected representatives. During the interim, we encourage you to continue conversations with your local lawmakers about how these changes will directly impact your practice and the treatment of patients in your community.
Find the contact information for your lawmakers here.
For questions, please contact WSDA Advocacy Director Kevin Schilling at kevin@wsda.org or WSDA Government Affairs Manager Lauren Johnson at lauren@wsda.org.
