Medicaid Revises Orthodontic Payment Policy Proposal

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In October 2016, Medicaid (now known as Health First Colorado) announced changes to its payment methodology for orthodontic providers, which was met by many concerns within the orthodontist community.

Many major issues came up, including potential rate cuts and lack of coverage for denied cases, which are highlighted in an updated bulletin issued in early April. Fortunately, the CDA was successful in helping mitigate many of these concerns, but there’s still more work to be done.

The CDA will continue working hard to address issues of continuity of care and administrative burden as the program transitions to a multiple payment system as opposed to a single, upfront payment system.

To tackle these concerns, CDA leadership recently met with a group of orthodontists to identify ongoing issues and has scheduled a subsequent meeting in late spring so this group can further the discussion. The CDA also is in the process of helping facilitate meetings with DentaQuest and the state to further discuss these issues.