Virginia Medicaid dental reimbursements to get boost for first time since 2005

Cindy Southern returned to Pulaski 22 years ago after following in her father’s footsteps as a dentist.

She was adamant that school-age children have access to dental care, especially those whose families struggled to make ends meet as the large factories began to close in the area.

Many of those children were on Medicaid and, more than two decades later, Southern’s Pulaski practice continues to see such recipients, though it’s no longer just children who have dental services covered by Medicaid. However, many Virginians face long waits for dental services now covered by Medicaid due to the mismatch between demand and providers.

The number of dental providers that accept Medicaid patients has fallen to 1,888 from a peak of 2,031 in 2017, according to data provided March 29 by Virginia Department of Medical Assistance Services.

Currently, there are 924,000 Virginian adults eligible for dental care through Medicaid, and 158,237 have had procedures since the new benefits were rolled out just over a year ago, according to Virginia Dental Association data.

Groups such as the VDA have been organizing for years to bring reimbursements for Medicaid dental services more in line with those dentists receive from other insurance providers. This year, for the first time since 2005, the reimbursements to providers of Medicaid dental services are being adjusted as groups hope the move will help grow the number of providers as the demand has swelled. The budget boosts the reimbursement rate by 30%.

“I’m hoping we’ll see more providers provide services because it’s definitely hard for people to get into a dentist,” said Southern.

The change comes from this year’s state budget, which went into effect Friday. The funding is $116 million sourced from state and federal funds, according to VDA information. The total two-year state budget is nearly $60 billion and includes various increases and cuts for different expenses.

The VDA has been pushing for years to adjust reimbursements for Medicaid as they had almost become neglected since 2005, according to Ryan Dunn, CEO.

Costs for keeping a dental practice open have gone up over the years, and up by around 60% just since the beginning of the pandemic, according to Dunn.

“Honestly, this 30% doesn’t really get us caught up, but it does get us closer to where we need to be,” he said.

For some procedures, it costs more for providers to perform them than they are reimbursed from Medicaid, according to Dunn.

Despite this, the adjustment is a step in the right direction, he and the other dentists said. Future and semiregular reimbursement adjustments are needed to maintain and expand the number of Medicaid dental providers, RON said.

“I don’t think we can go another 17 years without an increase,” he said.

Buckingham County dentist Walter Saxon Jr., who treats Medicaid patients, said there are other ways than reimbursement adjustments that could bring more providers into the fold.

He said incentives that help pay off student debt burdens could bring more young dentists into the fold, while incentives that support retirement funds could encourage older dentists to see more Medicaid patients.

Southern and Dunn agreed.

Southern thanked legislators for passing the budget that included the rate adjustment. She also said Virginia Department of Medical Assistance Services for it’s efforts in trying to find ways to attract more providers.

“They work really hard to make these programs work,” Southern said.