Medicaid reimbursement rates may be best tool to ensure dental care access in Oregon
Changing the Medicaid reimbursement will help ensure that everyone in Oregon has access to the dental care they need, an industry leader says. (Getty Images)
Oregon doesn't have enough dental providers.
Roughly 1 million Oregonians — including myself — live in a federally designated dental health professional shortage area. And more than 1.4 million Oregonians rely on the Medicaid-funded Oregon Health Plan (OHP). That's roughly one in three of us and one in two children across every county in our state.
Despite these large numbers, less than half of dentists in the state accept Medicaid as a form of dental coverage. Yet, many providers would be interested in doing so if they could make it financially worthwhile.
Nationwide, Medicaid pays significantly less than commercial dental insurance. And Oregon providers say that reimbursement from ALL carriers has not kept pace with the cost of doing business. Specifically, in the Evaluation of Oregon Health Plan Dental Provider Enrollment study from October 2024, researchers from the Oregon Clinical & Translational Research Institute noted:
Providers who accept OHP shared that they were 'in the red' – not making money – for any service beyond routine dental exams. For providers who accept OHP, the challenge of low reimbursement was compounded by the variability in fee schedules… This financial strain makes it difficult for practices to maintain profitability while delivering high-quality care.
I recently became president of Advantage Dental+, the leading dental program for more than 470,000 eligible OHP Medicaid members; I spend a lot of time thinking about ways to increase access to care and the impact this can have on one's overall health. Dental providers are struggling to provide the basic preventive services we all need to live healthy and feel well.
Right now, our state legislators are in session and they are in a position to help with this challenging situation. The newly proposed House bill 2957, sponsored by Representatives Javadi, Nosse and Pham, uses a data-based approach to reimbursing dental care providers, creating a better and more appealing payment mechanism to specifically address the issue.
This is a step in the right direction. It will help reduce rate volatility for dental providers, alleviating some of the financial unknowns associated with caring for the Medicaid population. The bill proposes aligning rate review and payment with the general process already used by commercial dental payors when determining rates for network providers. This includes adjusting to current market conditions, which is a key element providers have been missing.
The state's 2024 evaluation of OHP also proposes addressing reimbursement rates to promote access to care, as inadequate payment was the most common barrier to accepting Medicaid among providers. Dental offices are simply businesses that can only stay open if they can survive financially. The proposed change can only help ensure that everyone in our state has access to the care they need to live a healthy and happy life.
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