State Budget Includes More Funding for Oral Health Care; Redesign of Adult Dental Medicaid

Gov. Gretchen Whitmer and legislative leaders have approved the state’s fiscal year 2022-23 state budget, with positive outcomes for oral health care in Michigan. The changes include:

  • Increasing facility fee reimbursement for dental procedures performed at ambulatory surgical centers and outpatient hospital facilities.
  • $47 million of state money is to be appropriated to increase provider fees for adult dental Medicaid. With a federal match this amount is increased to $85 million.
  • $30 million of the total $85 million allocated for adult dental Medicaid is contingent upon the submission of a report on how to design a restructuring of the adult dental Medicaid program. The MDA will assist with the redesign.
  • Continued full funding for the Healthy Kids Dental and Michigan Donated Dental Services (DDS) programs.

Here is a summary of how the FY 2023 budget affects dentistry:

Facility fee reimbursement increase: The reimbursement for the facility fee for dental procedures performed at ambulatory surgical centers and outpatient hospital facilities was increased to $1,495 and $2,300 respectively (a $10 million investment by the state). This is a significant increase over the current rates and should help alleviate the backlog of cases for many special needs patients who were unable to receive care due, in part, to the extremely low fee paid to the facilities. The MDA has worked on this issue, along with other stakeholders, for years.

Increased fees for adult dental Medicaid providers: The budget includes $47 million of state money is to be appropriated to increase provider fees for adult dental Medicaid. With a federal match this amount is increased to $85 million. The MDA is working to obtain more details on how this will be implemented.

Redesign of adult dental Medicaid: An additional $30 million is being held and will be released contingent upon the creation of a plan to redesign the adult dental Medicaid program. The principles the MDA will advocate for as determined by MDA policy are as follows:

  • Ease of administration for patients and providers.
  • Issuing patients private insurance cards.
  • Allowing dentists who are non-participating with the insurance administer to participate with the government program.
  • Reimbursing at a rate at 60% of UCR or more.
  • Requiring that insurance administrators have an adequate provider network.
  • Requiring that insurance administrators have a plan to increase utilization.
  • Requiring that insurance administrators have a plan to decrease patient no-show rates.
  • Allowing access to data and reports on a timely basis.

Full funding for HKD, DDS: The Healthy Kids Dental program and the Michigan Donated Dental Services (DDS) program were fully funded for another year.

Overall, the budget contained positive developments for oral health care in Michigan. The changes detailed above will take effect no earlier than Oct. 1, 2022, when the new budget year begins. While these are good developments, the MDA will continue to advocate for additional investment and improvements in the adult dental Medicaid program as well as advocate for additional solutions to the access problem for patients requiring general anesthesia.