1. Medicaid Participation and Reimbursement for Physicians & Dentists in Every State
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2. The ADA Health Policy Institute

3. The ADA Health Policy Institute

4. The ADA Health Policy Institute

5. The ADA Health Policy Institute

6. Today
CHAIR Marko Vujicic, PhD, Chief Economist & Vice President, ADA Health Policy Institute PRESENTER Niodita Gupta, MD, MPH, PhD, Health Services Researcher, ADA Health Policy Institute

7. Today
PANELISTS
Donna Balaski, DMD, State of Connecticut Department of Social Services, Division of Health Services Dental Unit Michael Helgeson, DDS, Chief Executive Officer, Apple Tree Dental Stephen Zuckerman, PhD, Senior Fellow and Co-Director, Health Policy Center, Urban Institute

8. Today

9. Reimbursement in Medicaid
Medicaid Fee-For-Service Reimbursement Rates for Child and Adult Dental Care Services for all States, 2016

10. Reimbursement in Medicaid
We analyze Medicaid Fee-for-Service (FFS) reimbursement rate as a percent of:
Fees charged by the dentists
Private insurance reimbursement rate

11. Reimbursement in Medicaid
Data
Source
Medicaid FFS reimbursement data for 2016
State Medicaid program webpages
Private insurance reimbursement rates (2015 data inflated to 2016 dollars)
Truven Health Marketscan® Research Database
Fees charged by the dentists (2015 data inflated to 2016 dollars)
FAIR Health Dental Benchmark Module

12. Reimbursement in Medicaid
For children: All 50 U.S. states and D.C. For adults: States with extensive dental benefits to Medicaid-enrolled adults (AK, CA, CT, IA, MA, MT, NJ, NM, NY, NC, ND, OH, OR, RI, WA, WI)

13. Reimbursement in Medicaid
Procedures identified in: An Analysis of Dental Spending Among Children with Private Dental Benefits. ADA Health Policy Institute. April 2016 (Revised).

14. Reimbursement in Medicaid
An Analysis of Dental Spending Among Adults with Private Dental Benefits.
Procedures identified in: An Analysis of Dental Spending Among Adults with Private Dental Benefits. ADA Health Policy Institute. May

15. Reimbursement in Medicaid
Medicaid fee-for-service reimbursement relative to fees charged by dentists
Medicaid fee-for-service reimbursement relative to private dental insurance reimbursement
Child dental services
49.35%
61.81%
Adult dental services
37.20%
46.14%

16. Reimbursement in Medicaid (Children)

17. Reimbursement in Medicaid (Adults)

18. Comparing Dentists and Physicians
Medicaid Fee-for-Service (FFS) Reimbursement and Provider Participation for Dentists and Physicians in Every State

19. Comparing Dentists and Physicians
Data
Source
Medicaid reimbursement for dentists
Medicaid Fee-For-Service Reimbursement Rates for Child and Adult Dental Care Services for all States, ADA Health Policy Institute. April 2017.
Medicaid reimbursement for physicians
Medicaid Physician Fees after the ACA Primary Care Fee Bump. Urban Institute. March 2017.
Report to the Congress: Medicare Payment Policy. March 2017.
Medicaid participation for dentists
Dentist Participation in Medicaid or CHIP. ADA Health Policy Institute.
Medicaid participation for physicians
Acceptance of new patients with public and private insurance by office-based physicians: United States, NCHS data brief. March 2015;195:1-8.

20. Reimbursement and Provider Participation

21. Reimbursement and Provider Participation

22. Reimbursement in Medicaid

23. Key Takeaways What We Learned… Further Thoughts…
As a share of private insurance reimbursement, Medicaid FFS reimbursement for child dental services is higher than for adult dental services
As a share of private insurance reimbursement, Medicaid FFS reimbursement is similar for dentists and physicians
A higher share of physicians participate in Medicaid than dentists
Further Thoughts…
Why do Medicaid programs treat adult dental services differently than child dental services?
Why are some states reimbursing physicians and dentists differently within Medicaid?
Do we need more dentists participating in Medicaid? If so, how do we get there?

24. Donna Balaski
State of Connecticut Department of Social Services, Division of Health Services Dental Unit

25. Chief Executive Officer, Apple Tree Dental
Michael Helgeson
Chief Executive Officer, Apple Tree Dental

26. Senior Fellow and Co-Director, Health Policy Center, Urban Institute
Stephen Zuckerman
Senior Fellow and Co-Director, Health Policy Center, Urban Institute

27. Roundtable
Marko Vujicic, PhD, Chief Economist & Vice President, ADA Health Policy Institute
Niodita Gupta, MD, MPH, PhD, Health Services Researcher, ADA Health Policy Institute
Donna Balaski, DMD, State of Connecticut Department of Social Services Division of Health Services Dental Unit
Michael Helgeson, DDS, Chief Executive Officer, Apple Tree Dental
Stephen Zuckerman, PhD, Senior Fellow and Co-Director, Health Policy Center, Urban Institute

28. @ADAHPI ADA.org/HPI hpi@ada.org
Thank You!
@ADAHPI ADA.org/HPI