Georgia Medicaid’s coverage of dental services has a storied history, and Georgia Dental Association (GDA) has been heavily involved in advocating for public insurance that works for patients and dentists. An exploration of the recent past and present suggests a need for continued efforts focused on improving Georgia Medicaid’s dental benefits. A recent history of dental Medicaid in Georgia A review of GDA’s documents on the state’s Medicaid history is illuminating. GDA began tracking and working with dental Medicaid in the 1980s, and until fiscal year 1999, Georgia Medicaid’s dental reimbursement remained flat. Over the period from 1987 to 1999, the purchasing power of dental reimbursements was cut in half due to a lack of fee increases to match growing prices. By 1999, there were only 257 providers willing to take new Medicaid patients. Fiscal year 2001 brought big gains for dental Medicaid when legislators raised fees to the 75th percentile of dentists’ usual customary and reasonable charges, mirroring a similar effort undertaken by South Carolina the year before, and GDA implemented the Take Five Program, increasing dentist enrollment in Medicaid by almost 500 over 21 months. The focus on financial support for dental Medicaid was short-lived. By 2004, the Department of Community Health began to focus on cutting its budget. They eliminated 11 CDT codes from Medicaid and PeachCare that year and proposed a Georgia’s Ever-Shifting Dental Medicaid Landscape Jon Hoin, GDA Health Policy Specialist total elimination of dental benefits in 2005 and 2006. The programs were preserved with significant budget cuts. Further efforts to control costs followed, and in 2006, Georgia entertained bids from Care Management Organizations in an effort to shift the programs’ financial risk to other parties. Various rounds of cuts to Medicaid spending continued through the period following the 2008 financial crisis. Only in 2017 did legislators begin to raise rates again. Assessing Georgia’s current dental Medicaid benefit In its 2024 legislative session, Georgia’s General Assembly directed the Department of Community Health to remove dental coverage limitations on adults over the age of 21. As a result, dental Medicaid coverage has been expanded to all adults in the Medicaid and PeachCare programs. Previously, coverage for adults was limited to emergency care except for certain eligible individuals such as pregnant women. The addition of an expanded adult benefit places new emphasis upon reimbursement rates. Studies have found that a Medicaid expansion's effectiveness in enhancing access to care depends on several factors.1 Insurance is only half the battle: Access to care requires a supply of dentists to provide it.2,3 To have a supply of dentists, reimbursement rates must be appropriately high and administrative burden limited.4 Without a sufficient supply of open spots, Medicaid recipients will compete with each other for available appointments, and some may find themselves without care as a result.2 Currently, Georgia’s reimbursement rates are well below historical benchmarks proven to attract providers. Just under half of the 20 most frequently used CDT codes fall below the regional average. The adjacent graph compares reimbursement rates, most of which were published summer of 2024, between states, as well as with the Southeastern Average from the American Dental Association’s 2022 fee survey adjusted for inflation (Figure 1). Notably, the gap between Georgia’s rates (red dot) and dentists’ fees (orange dot) is large. The ADA reported last year that in 2022 Georgia Medicaid’s fee for service max reimbursement represented just 43.8% of fees charged, a discount of over 50% and a far cry from the more common discount range of 20%-40% negotiated by private insurance companies.5 Inflation has taken a bite out of that 43.8% since that report, and that figure does not account for lower rates paid by Care Management Organizations.5 The real picture of dental reimbursement in Georgia is even more drastic than the graph suggests. Anecdotally, many dentists suggest they are receiving 30 cents on the dollar or less. The insurance mix at which accepting Georgia’s Medicaid reimbursement rates becomes totally unsustainable depends on a whole host of factors ranging from the level of negotiated discounts with private insurance companies to differences in care utilization between Medicaid and private pay populations. At the patient level, 30 | Nov 2024
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