From the Journal of the Colorado Dental Association Autumn 2024
By Kevin Patterson, D.D.S., M.D., CDA President
Becoming a Medicaid provider is an important decision for any dentist. While many of you may initially shy away from the program due to perceptions about lower reimbursement rates or administrative challenges, there are numerous compelling reasons why you should consider becoming a Medicaid provider. The reasons are inherently obvious and include expanding patient access and fostering community well-being to ensuring financial sustainability and fulfilling a moral obligation. The decision to accept Medicaid can have far-reaching benefits.
Over 22% of Coloradans are insured by Medicaid, so a large segment of OUR community relies on this program. I have been a Medicaid provider since 1998, at a time when the administrative burdens were greater and the reimbursement rates were much lower. Below I have included a much deeper dive into my reasons for the WHY.
- Expanding Access to Care
One of the most pressing reasons for you to become a Medicaid provider is the opportunity to expand access to dental care for underserved populations. Colorado, like many other states, has a significant population of low-income residents who rely on Medicaid for their healthcare needs. By accepting Medicaid, you can provide essential oral health services to individuals who might otherwise go without care. This includes children, the elderly, and disabled individuals who are disproportionately affected by dental health disparities.
Oral health is intimately associated with overall health, where untreated dental issues can lead to more serious health complications. By providing dental services to Medicaid recipients, you can help prevent the progression of oral health problems and contribute to better health outcomes for your patients. Expanding access to care is not only beneficial for patients, but also aligns with the broader goals of public health and community well-being.
- Financial Sustainability
While it is true that Medicaid reimbursement rates can be lower than those of private insurance, it is important to note that recently this has significantly changed in Colorado due to the hard work of the CDA Medicaid Committee over the last two years. Colorado has seen the elimination of the cap for adult Medicaid and recently had 28 codes increased to 70-100% of the ADA 2020 fee schedule. These changes have placed Colorado at the forefront of Medicaid reform with significantly increased rates for periodontal and endodontic procedures. As such we are also now calling on our dental specialists to enroll in Medicaid as specialty care is often difficult for a patient to find.
Find the 2024/2025 Medicaid Reimbursement Rates here.
In addition to the Medicaid reimbursement rate increases for dental services mentioned above, there was a 2% across the board fee increase on all dental codes as of July 1, 2024. The state has made efforts to increase Medicaid reimbursement rates for dental providers, recognizing the importance of oral health and the need to incentivize provider participation. Now it is up to dental providers to show that these fee increases do in fact lead to more providers who participate and see patients with Medicaid, which is the definition of increasing access to care.
In 2026, dental services provided by Medicaid are scheduled for a full rate review where hopefully the reimbursement rates for additional codes will occur. If we can’t show that the 2024 increase has led to an increased number of providers, our chances for increased reimbursement for additional codes will be difficult to achieve. On a more positive note, Medicaid reimbursement for the 28 codes listed above are now higher than some private insurance plans, making it a more viable option for Colorado dentists.
- Fulfilling a Moral and Ethical Obligation
Dentists, like all healthcare professionals, have a moral and ethical obligation to care for those in need. The American Dental Association’s Principles of Ethics and Code of Professional Conduct emphasizes the importance of providing care to all people, regardless of their financial status. The mission and vision of the CDA is to improve oral health for all residents of Colorado. By becoming a Medicaid provider, you can fulfill this ethical obligation and contribute to reducing health disparities in your community.
Low-income individuals, children and marginalized populations are often the most vulnerable to poor oral health and the least likely to have access to regular dental care. By accepting Medicaid, a dentist can help bridge the gap in care and ensure that everyone, regardless of income, has access to essential dental services. This commitment to social responsibility can be deeply rewarding and can help foster a sense of pride and fulfillment in one’s professional life.
- Addressing the Needs of a Growing Population
Colorado’s population is growing, and with it, the demand for dental services. As the state continues to attract new residents, the need for accessible and affordable healthcare becomes even more critical. Medicaid is an essential part of the healthcare safety net in Colorado, and by becoming a Medicaid provider, you will play a vital role in meeting the needs of a growing and diverse population.
Moreover, Colorado’s Medicaid expansion under the Affordable Care Act has increased the number of people eligible for Medicaid, including adults without children who previously did not qualify. This expansion has created a larger pool of potential patients who need dental care, further emphasizing the importance of having more Medicaid providers in the state.
- Contributing to Health Equity
Health equity is a key priority for policymakers and healthcare professionals alike. By accepting Medicaid, you can contribute to the broader goal of achieving health equity. This means ensuring that everyone, regardless of socioeconomic status, has the opportunity to achieve optimal health outcomes. Dental health is a critical component of overall health, and by providing care to Medicaid patients, dentists can help reduce disparities and promote health equity in their communities.
I hope that after reading this article you will all see that becoming a Medicaid provider in Colorado offers numerous benefits, both for the dentist and more so for the community you serve. From expanding access to care and promoting health equity to ensuring financial sustainability and fulfilling ethical obligations, the decision to accept Medicaid is one that can have a lasting positive impact. While there may be challenges associated with participating in the Medicaid program, the rewards — in terms of patient care, community well-being and professional satisfaction — are well worth the effort.
