Medicaid Participation and Reimbursement for Physicians & Dentists in Every State Thank you for joining! You will be on hold until the call begins at 10:30 a.m. Central time Please remember to mute your phone unless you are speaking. This webinar will be recorded. Streaming audio is available through your computer If you’d like to call in to listen to the audio via phone, dial (888) 378-4398 and enter conference ID: 514559

The ADA Health Policy Institute

The ADA Health Policy Institute

The ADA Health Policy Institute

The ADA Health Policy Institute

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

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

Today

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

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

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

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)

Reimbursement in Medicaid Procedures identified in: An Analysis of Dental Spending Among Children with Private Dental Benefits. ADA Health Policy Institute. April 2016 (Revised). http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0316_3.pdf

Reimbursement in Medicaid An Analysis of Dental Spending Among Adults with Private Dental Benefits. http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0516_1.pdf Procedures identified in: An Analysis of Dental Spending Among Adults with Private Dental Benefits. ADA Health Policy Institute. May 2016. http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0516_1.pdf

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%

Reimbursement in Medicaid (Children)

Reimbursement in Medicaid (Adults)

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

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, 2016. ADA Health Policy Institute. April 2017. http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0417_1.pdf Medicaid reimbursement for physicians Medicaid Physician Fees after the ACA Primary Care Fee Bump. Urban Institute. March 2017. http://www.urban.org/sites/default/files/publication/88836/2001180-medicaid-physician-fees-after-the-aca-primary-care-fee-bump.pdf Report to the Congress: Medicare Payment Policy. March 2017. http://www.medpac.gov/docs/default-source/reports/mar17_entirereport.pdf?sfvrsn=0 Medicaid participation for dentists Dentist Participation in Medicaid or CHIP. ADA Health Policy Institute. http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIGraphic_0217_1.pdf?la=en Medicaid participation for physicians Acceptance of new patients with public and private insurance by office-based physicians: United States, 2013. NCHS data brief. March 2015;195:1-8. https://www.cdc.gov/nchs/data/databriefs/db195.pdf

Reimbursement and Provider Participation

Reimbursement and Provider Participation

Reimbursement in Medicaid

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?

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

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

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

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

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