North Carolina Health News: Dentists Lobby for Higher Reimbursement Rates

The phones at many dental offices across North Carolina have been ringing repeatedly in recent months with requests for oral health care from newly enrolled Medicaid recipients.

The state’s expansion of Medicaid benefits to nearly 600,000 low-income residents on Dec. 1 opened a robust array of services such as dental exams, routine cleanings and more complicated care for many people who previously had little access to a dentist because of the cost. 

“The phone’s ringing off the hook,” said Robert Stowe, a dentist with Winston Smiles Dentistry in Winston-Salem. 

One of those calls, Stowe said, was from a woman who had not been to a dentist in 15 years. She needed 12 teeth extracted, he added, and would need partial dentures made to fit between her remaining teeth. She was not yet 50 years old.

Some of the new patients have needed oral surgery. Because no oral surgeons in Forsyth County are taking any new Medicaid patients, Stowe said, he has to refer those clients to other counties.

“I’ve spoken to oral surgeons in Winston and tried to get them to take some of these people,” Stowe told NC Health News in an interview. “They tell me: ‘The deal is this. These folks are the sickest.'”

Many of the new beneficiaries are not comfortable with a dentist or oral health provider since such care often was out of reach for them. Many want or need to be sedated when they need extensive work, which can require additional resources.

The problem is, many dentists say, is the state reimbursement rate for dental patients on Medicaid insurance plans is 34 cents on the dollar. That’s the same rate that dentists received in 2008.

Two versions of a meeting

Frank Courts, chair of the North Carolina Dental Society Council on Oral Health and Prevention, said the rate has been increased several times during that 16-year period, most recently during the COVID pandemic. Those increases have been temporary, though, and the rate has dropped back to a level that many in the state’s private dental industry say is too low for them to accept any new Medicaid patients.

Dentists have tried through the years to get a long-term increase, but “nothing significant has happened,” Courts told NC Health News.

Courts and some of his colleagues have been trying again recently to persuade state leaders that a rate increase is the way to get more private dentists to see Medicaid beneficiaries. Only about 45 percent of North Carolina dentists currently do. 

Courts, Stowe and Richard Dest, a dental clinic owner who has been treating Medicaid patients since 2007, met recently with Jay Ludlam, deputy secretary for NC Medicaid at the state Department of Health and Human Services. They laid out their concerns for him.

They said Ludlam told them he had sent a budget proposal to the governor’s desk that calls for a 30 percent increase of the Medicaid reimbursement rate in the coming fiscal year, but he cautioned them that it was likely to be pared down.

To a request for comment on Tuesday, DHHS sent the following response: “As we see more residents of North Carolina access care through NC Medicaid, it is increasingly important that we maintain provider access.

“Many providers, including dentists, have not seen a sustained rate increase since 2012-14 despite the increases in costs in the last 10 years,” the department statement continues. “NCDHHS is evaluating proposals to increase rates during the short session for providers to account for 2024 costs. Deputy Secretary for NC Medicaid, Jay Ludlam has not sent a letter of recommendations to the Governor about Medicaid reimbursement rates for dental providers. NC Medicaid is in the process of submitting items for potential inclusion in the Governor’s budget proposal. That work is ongoing.”

Dest, who said he doesn’t mind rattling cages, provided NC Health News with his email correspondence with Ludlam that led him to believe that a proposal had been “sent to the governor’s desk.” 

In an email sent Feb. 16 to Ludlam, Dest wrote: “Good afternoon. Were you able to put it on the Governors (sic) desk today?” Ludlam responded late that afternoon: “Our budget team submitted to the office of state budget and management.”

Then on Feb. 20, Dest checked in with Ludlam again. “Good morning Jay. Any updates from the governors (sic) desk?,” Dest wrote in an email that also included his plans to hire another dentist. “The rate increase cannot come fast enough.”

Ludlam responded about an hour later: “We met and presented the ask. Short session will start around April 1. Little I can do between now and then other than echo what we discussed last week.”

Developing a budget

Governor Roy Cooper has not yet released his proposed spending plan for the fiscal year that begins July 1. 

The state budget office works with the governor to develop a statewide plan. Typically, the governor releases his proposal to the public in mid-March after revenue projections make it clearer how much will be in state coffers. Then it goes to the General Assembly, which might or might not include anything from the governor’s proposal in the multibillion-dollar budget that lawmakers put forward.

“This 30 percent increase would be very significant, but we are concerned with how meaningful it is,” Courts added.

Some estimates among oral health care providers suggest that reimbursement rates would need to be 75 cents on the dollar to build an adequate private provider network. 

The cost of running a dental practice has risen significantly over the past 15 years as X-ray machines and other equipment have gotten more expensive. As the cost of living rises, so do salaries for hygienists and dental assistants.

“We try to take care of our patients out there,” Stowe said. “We are trying to pay our staffs. We are small business owners with thousands of workers across the state.”

“I’m at the point in my life where I can give back some,” added Stowe, whose practice provides care for Medicaid recipients.

Others might not have that luxury, Stowe said.