Dental Provider Participation in Medicaid and RIte Smiles

• Nationally, children and adults with public insurance coverage face access problems because many private dentists do not accept Medicaid for payment. Dental providers cite low reimbursement rates, cumbersome administrative requirements, and patient-related issues (e.g., missed appointments and poor treatment compliance) as reasons why they do not see more patients with Medicaid coverage. Additional access barriers for children and families with public insurance include difficulty with transportation, lack of child care, and issues with paperwork. Family education, case management, and streamlining administrative procedures can encourage provider enrollment and patient utilization.
• Since RIte Smiles started in 2006, reimbursement rates have been raised for participating dental providers.29 The number of dentists accepting qualifying children increased from 27 before RIte Smiles began to 90 at the launch of RIte Smiles. In FY 2018, there were 309 unduplicated dentists in 195 practice locations participating in RIte Smiles.
• General dentists and dental specialists who provide dental care to youth who do not qualify for the RIte Smiles program (currently between the ages of 18 and 21) continue to be reimbursed at the Medicaid fee-for-service reimbursement rate. Medicaid reimbursement rates often lag behind fees charged by dental providers and private commercial rates, which reduces incentives for providers to treat children with Medicaid coverage. Rhode Island had the fifth lowest Medicaid fee-for-service reimbursement rate for pediatric dental services in the nation in 2016.

Consequences of Untreated Dental Disease

• Between 2013 and 2017, an average of 557 children under age 21 were treated for a primary dental-related condition in Rhode Island emergency departments annually. Of these children and youth, 23% were ages five and under, 18% were ages six to 11, 17% were ages 12 to 17, and 42% were age 18-20.
• Each year between 2013 and 2017 in Rhode Island, an average of 67 children under age 19 were hospitalized with a diagnosis that included an oral health condition. During this time period, an average of 16 children per year under age 19 were hospitalized with an oral health condition as the primary reason for the hospitalization.

This has been excerpted from the 2019 Rhode Island KIDS COUNT Factbook. To see the full publication, please click here!