Other
Akilah Artis, DDS (she/her/hers)
Pediatric Dentistry Resident
Children's Healthcare of Atlanta
Children's Healthcare of Atlanta
Atlanta, Georgia, United States
J C Shirley, DMD, MS, MSc
Division Chief, Pediatric Dentistry and Orthodontics
Children's Healthcare of Atlanta
ATLANTA, Georgia, United States
Colton L. Fowlkes, DMD (he/him/his)
Pediatric Dental Resident
Children's Healthcare of Atlanta
Children's Healthcare of Atlanta
Atlanta, Georgia, United States
J C Shirley, DMD, MS, MSc
Division Chief, Pediatric Dentistry and Orthodontics
Children's Healthcare of Atlanta
ATLANTA, Georgia, United States
Brittany Waters, DMD
Pediatric Dentistry Residency Program Director
Children's Healthcare of Atlanta
Atlanta, Georgia, United States
Purpose: The aim of this paper was to evaluate current dental reimbursement rates for Georgia Medicaid plans for services provided for young children with cleft and craniofacial disorders.
Methods: Reimbursement rates from three Medicaid managed care dental plans and a Medicaid Fee for Service (FFS) plan were compared with non-Medicaid rates for 12 common procedures for children with cleft and craniofacial disorders. An index was created for each of 12 common procedures by using a weighted average from a proportion of total numbers of procedures. Information from the dental plans contracted by the Medicaid Care Managed Organizations (CMOs) and Department of Community Health (DCH) data were used to compare to recent American Dental Association (ADA) Survey of Dental Fees data.
Results: The average reimbursement for dental services from dental plan administrators contracted by CMOs is only 31% of non-Medicaid dental reimbursement. The three procedures with the most significant discrepancy between Medicaid and non-Medicaid rates were: orthodontic treatment, extractions, and restorations. One CMO provided higher reimbursement for all procedures to providers in rural locations versus providers in urban locations.
Conclusion: Medicaid reimbursement rates for dental services for young children with cleft and craniofacial disorders are significantly lower than non-Medicaid rates. Low reimbursement rates have impacted provider participation and the overall performance of the Georgia Medicaid program. Improvement efforts should be directed at creating reimbursement schemes that are more competitive with non-Medicaid reimbursement and provide incentives for providers who provide care for certain special needs populations.