NC doesn’t pay dentists enough to treat Medicaid beneficiaries, new report says • NC Newsline

Dental care is sometimes an afterthought when it comes to health, but untreated cavities can not only cause a sore jaw, but can also harm your health and cost you a job.

A report released last week by the Oral Health Transformation Task Force envisions a future for North Carolina’s oral health that is “comprehensive and seamlessly integrated with overall health.” The task force report was prepared under the auspices of the North Carolina Institute of Medicine and focuses on Medicaid recipients and other low-income individuals.

State Medicaid Director Jay Ludlam said he hopes the report emphasizes the importance of dental health and the far-reaching consequences of neglected teeth.

“I hope people recognize the importance of dental health and see it as something worth investing in and discuss how we can provide better dental care for dentists, the dental community and the people of North Carolina,” he said during Friday's presentation interviewing.

Jay Ludlam
Jay Ludlam, North Carolina DHHS Deputy Secretary for North Carolina Medicaid (Photo: North Carolina DHHS)

The report comes as more low-income adults who qualify for expanded Medicaid coverage are seeking dental care. Governor Roy Cooper announced that as of April 1, 400,000 North Carolinians were enrolled in expanded Medicaid. Since its introduction on Dec. 1, Medicaid has covered more than $11.2 million in claims for dental services for people under expanded coverage, according to a news release from his office.

The report found North Carolina offers “the strongest adult Medicaid dental coverage in the nation.” It is one of 25 states that offers comprehensive dental coverage to adults.

However, not all Medicaid beneficiaries have access to this care.

Ninety-four of the state's 100 counties have a shortage of dental health professionals. Dental care can be difficult to find in rural areas. Four eastern counties have no dentists, according to the Sheps Center for Health Services Research at the University of North Carolina. Approximately 40% to 45% of active licensed dentists participate in the Medicaid dental plan. Many are not accepting new patients, the report said. In 2022, dental procedures accounted for 14% of services to Medicaid beneficiaries. About 2% of Medicaid payments go to dental providers.

About 15% of kindergarten children have untreated cavities.More than half of children and young adults ages 1 to 20 eligible for Medicaid receive preventive dental care, according to the state Department of Health and Human Services data.

Tooth decay can make it impossible to eat certain foods. Cavities or missing teeth can be a stumbling block to finding a job. A 2015 survey of North Carolinians by the American Dental Association found that 18 percent of adults said the appearance of their mouth and teeth affected their ability to interview for a job. More than 20% said they avoid smiling due to the condition of their mouth and teeth.

Dentists want to move away from Medicaid managed care

Despite calls for strengthening the connection between oral health and physical health, the 118-page task force report stopped short of recommending that dentists be included in the state's Medicaid managed care program launching in 2021. A health plan in which the insurance company is paid a certain amount per person who enrolls and provides health care within the limits of the funds it charges.

Dental care is still “fee-for-service,” meaning dentists are paid for each procedure they perform.

The task force's report explains how dental care can be excluded from Medicaid managed care coverage.

“Many oral health professional stakeholders have historically preferred to keep the dental service delivery model independent, autonomous, and customized to the unique characteristics of the dental practice,” the task force report said. “When North Carolina Medicaid transitioned from fee-for-service to managed care and transferred state administrative responsibilities to managed care organizations, many advocated for the elimination of dental services.”

Jim Goodman
Jim Goodman, executive director and CEO of the North Carolina Dental Association (Photo:

Jim Goodman, CEO of the North Carolina Dental Association, said in an interview Thursday that dentists still want to separate Medicaid dental plans from managed care.

The main problem, he said, is that payment rates have not changed since 2008.

“We need to make changes that promote the long-term sustainability of serving the state’s patients currently on Medicaid,” Goodman said. “To do that, the first step must be to increase reimbursement rates. Since 2008 They have not increased since years.

More dentists will see more Medicaid recipients or add them as patients, but “seeing more and more Medicaid patients could bankrupt you,” Goodman said. “We have some well-intentioned and excellent dentists who want to do this, but they are also small business owners. We hope people can appreciate that balancing act.

Support increased Medicaid payments

Medicaid reimbursement rates for some dental procedures are actually lower now than in 2008, the report said. For example, in 2008, Medicaid paid $29.93 per tooth to apply sealant. Payments that keep pace with inflation are $39.44 per tooth, the report said.

“This is unsustainable for dental practices,” the report said.

Cooper's budget proposal released last week includes a $265 million increase in state funding that would allow Medicaid to pay dentists more.

Ludlam said the rate hike funding proposed in Cooper's budget would increase payments to dentists who treat regular Medicaid patients. Dentists will also get higher rates when they treat people under expanded Medicaid, but none of the money to support their increased rates will come from the state coffers. The federal government covers 90 percent of the cost of care for people covered by Medicaid expansion, with the rest coming from increased hospital assessments.

While acknowledging that Medicaid beneficiaries have difficulty finding a dentist to treat them, the report recommends that North Carolina Medicaid provide “dental home” support for patients, encouraging them to develop a relationship with an office-based dentist where they will receive comprehensive and ongoing care. care.

Central to the proposal is the creation of compensation standards for dentists that take into account preventive care and complex needs.

“It's a good move,” Ludlam said, although there may not be enough dentists initially.

“What we need to continue to do is invest in innovation in the way we deliver dental care,” he said.

As Medicaid rates increase, more dentists will accept government insurance, he said. “It’s a virtuous cycle that works together.”

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