Dental Medicaid gets budget boost

July 12, 2021

Wisconsin State Budget includes increased reimbursement for dental Medicaid to help expand dental care for the underserved.

OHP Legislator Meeting

L to R: Al Jamir, Emeritus OHP Board Member, Michael Schwartz, Executive Director Oral Health Partnership; Robert Cowles, Wisconsin State Senator; Heidi Selberg, OHP Board Member; Jack Laduc, OHP Legislative Education Committee Member and Benjamin Hayes, OHP Board Member met early 2020 in Green Bay to discuss how OHP has used the enhanced Medicaid reimbursement to increase service and improve kids’ oral health.

Included in the newly passed Wisconsin state budget is a 40% statewide increase in Medicaid reimbursements for dental providers. Oral Health Partnership (OHP), Wisconsin Dental Association and numerous other dentists have worked toward the increase believing it will lead to greater access and improved oral health for underserved patients across the state.

OHP, a nonprofit that cares exclusively for children birth to 19 years old that are uninsured or underinsured, knows the impact of enhanced Medicare reimbursement firsthand. Since 2017, OHP has been part of a pilot program to measure whether greater reimbursement rates would increase access for kids in need. As a result of the enhanced pilot rates, from 2017 to 2020, OHP alone treated 3,676 additional children during 17,345 appointments, opened two additional clinics (9 operatories), hired two pediatric dentists and three hygienists all of which increased access. It is estimated that without the enhanced rates, OHP would have treated 8,500 fewer patients during 20,000 fewer appointments because it would have had to limit services due to nationwide low rates.

“Through the pilot program we were able to add staff and space, leading to an expansion of patients seen, procedures done and improvement in the overall dental health of the children in Brown County,” said Michael Schwartz, Executive Director of OHP. “But we also see patients from all over the state, with some driving hours to get dental care. Though we love helping kids and seeing smiles, making care easier and more accessible will lead to more kids getting care even closer to home. Increasing access to care is the very heart of our mission.”

In the past, many dentists chose not to see or limit the number of patients that are using Medicaid, given the low reimbursement rates. This has led to a dental healthcare gap in the state of Wisconsin, leaving people struggling to find care, traveling long distances to get service, or neglecting dental care until having major problems. By increasing reimbursements rates, dentists and nonprofit dental clinics can increase the number of patients on Medicaid knowing they will receive reimbursement amounts that are much more financially sustainable.

“We have been working toward this for over five years,” said Schwartz. “We are thrilled about the possibilities of expanded access for everyone and better health for people, especially children, across Wisconsin.”


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