Georgia’s Ever-Shifting Dental Medicaid Landscape — continued typical patient needs based on payor status were addressed, and so was the fact that the relative value of Medicaid quoted by the ADA’s Health Policy Institute, 44% of average dentist charges, is derived from Georgia’s maximum dental fee schedule. Historically, the Care Management Organizations handling Georgia Medicaid drive fees down even further. The scenario above systematically overestimates the value of public insurance payments. Furthermore, many practices spend more on necessary expenses, and workforce conditions are likely to continue to drive the cost of running a practice even higher in the near term.9 To cover all of a practice’s expenses, including dentist salaries, the scenario above requires an insurance mix that provides an average of 73% reimbursement of fees charged. Every practice has its own version of this calculation. It is important to realize that this hypothetical is just that, a hypothetical, but it illustrates the financial dynamics present in deciding whether, and how often, to accept Medicaid patients. These dynamics are why it is so important for policymakers to support adequate reimbursement levels for dental services in the Medicaid program, particularly for preventative care.7 Upcoming legislative conversations With a new legislative session comes a new opportunity to advocate for improvements in Georgia’s dental Medicaid services. Raising rates to reasonable levels works to drive provider participation, and recent legislative successes in other states suggest potential strategies for future advocacy efforts.4,10 Ohio saw a 93% increase in rates after drawing attention to the impact of failing to raise rates for 20 years.10,11 Missouri raised rates to 80% of the 50th percentile and saw over 100 providers sign up.10 Accomplishments like this are group efforts, and GDA needs all hands on deck to make sure that Medicaid’s dental reimbursement levels work for all Georgians. Addressing Medicaid reimbursement is a continuous process, and without ongoing efforts, history suggests this essential component of the dental health system will be neglected. Estimating Average Billings Collected Per Patient Visit by Insurance Status in a Private Practice Difference of Revenue to Expense Treating Only Medicaid Patients in Ideal Scenario Table 1 32 | Nov 2024
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