Most dentists, whether or not they accept Medicaid and Medicare, agree that increased reimbursements are the most important update that needs to be made to improve the programs.
Low reimbursement rates are a big reason why many dentists do not accept patients covered by Medicaid and Medicare. The stagnant reimbursement rates are also causing some dentists who do currently treat patients in the program to potentially drop out.
These five dentists recently connected with Becker's to share their experience with the dental Medicaid and Medicare programs, as well as how they could be improved to expand participation among dentists.
Note: Responses were lightly edited for clarity and length.
Question: Do you accept Medicaid and/or Medicare at your practice and what changes would you like to see made to the programs?
Jeremy Burgin, DDS. Owner and dentist of Burgin Dentistry (Clovis, N.M.): No, I do not accept Medicaid, and I do not plan on it anytime soon. The problem lies in two different areas. Patients usually do not show up to their appointments because they have nothing invested in the appointment. There are no consequences if they do not show for treatment. The second reason is that the reimbursement rates are very low. Profit margin is extremely low. I don't expect the government will change the reimbursement rates at all or at least anytime soon and for that I will not accept Medicaid.
Kevin Nakagaki, DDS. Dentist of HealthPartners (St. Paul, Minn.): Yes, we do accept the programs at our practice and we will continue accepting it in 2025. I would like to see reimbursement amounts for Medicaid and Medicare to be increased.
Alan Peet, DDS. Oral surgeon of Olympic Peninsula Oral Surgery & Implants (Sequim, Wash.): I do take Medicare, but I plan on dropping it. Reimbursement this past year is a big problem, I have not been able to get paid this year. I have taken Medicare to help senior citizens who need biopsies.
Rafael Rivera, DDS. Dentist and owner of Smile Starters Dental (Charlotte, N.C.): We do accept Medicaid at our dental practice and we plan to continue accepting Medicaid as it is the backbone of our practice. We are overdue for a reimbursement increase. In our state, North Carolina, we haven't had a dental reimbursement increase in 17 years. Providers are paid less per procedure than they were in 2008. Many providers have stopped accepting new Medicaid patients and access to care is suffering. My take is that our state reimbursement needs a 40% increase.
Robert Trager, DDS. Dentist at JFK Airport (New York City): In my original office in Jamaica Queens, N.Y., I accepted Medicaid for 42 and a half years until a physician bought the building and ousted me out of my office and took over my office space for his practice. I practiced in a minority neighborhood as a service to the community. Many of my patients appreciated the fact that I accepted their Medicaid plan and gratefully appreciated my service. It was a rewarding experience for me accepting and helping these patients to receive quality dental treatments and they reciprocated by bringing my staff and me Christmas presents.
My only concern was where the reimbursements were adequately too low for the quality of service that I provided using the same laboratory and materials that I used for private and insurance benefit patients. Now that I practice on patients from the John F. Kennedy and LaGuardia airports I do not have any Medicaid or Medicare request and if I did, I would refuse them based on the low reimbursement fees.
The constant and increasing fraud by fellow dentists in this program is perpetrated by these still lower reimbursement fees. These fees have not risen to keep up with the inflation. This program is poorly designed and leads to fraud. Some of the reimbursements are less than the laboratory fees for a quality product. Until this Medicaid program reimburses vendors a fair and equitable fee for services rendered then the temptation will always be there to abuse the program. I do not anticipate accepting Medicaid patients at the airport unless there is a dramatic change in reimbursement policies.