Evaluation Findings from Wisconsin Four-County Medicaid Dental Reimbursement Pilot

Summary:

  • The pilot sought to test whether more dentists would enroll in Medicaid and more people would receive services after reimbursement rates were more than doubled in four counties.
  • The results are modest, at best.  Dental service use increased by an average of 4 percentage points for children and 5 percentage points for adults, with a wide range among the pilot counties. 
  • The major problem with the way the study was designed is that it is impossible to tell what caused the modest increase, according to evaluators.  This is troubling because, as the report notes, during the same time as the pilot, Federally Qualified Health Centers significantly increased dental service use with additional federal funding they were awarded.  FQHCs are often the major provider of Medicaid dental care in their communities, according to the evaluation.
  • In terms of dentist enrollment across the four counties, an additional 57 dentists enrolled in Medicaid (an increase of 34%); of those, 46 treated Medicaid patients. 
  • Overall, the pilot results demonstrate that raising Medicaid reimbursement rates will not make a sizeable dent in Wisconsin’s dental access problem.  If the pilot results were applied statewide, the portion of dentists enrolled in Medicaid would rise from 32% to 43%.  The portion of Medicaid children accessing dental care would increase from 43% to 47%, still leaving more than 278,000 children without care.   And, the portion of Medicaid adults accessing dental care in the state’s 68 other counties would increase from 26% to 32%. 
  • Wisconsin needs additional strategies to make a meaningful improvement in dental access.


Background:
In Wisconsin, only 32% of dentists were enrolled in Medicaid in 2015[i] and only 43% of Medicaid children received dental care in 2017.[ii]  As an experiment to try to increase both dentist participation in Medicaid and more dental visits among Medicaid children and adults, Wisconsin’s Medicaid program more than doubled reimbursement rates for dental care in the counties of Brown, Marathon, Polk and Racine (In 2016 Wisconsin Medicaid reimbursed at 36% of private insurance rates for children’s dental services, and 31% for adult dental services.[iii]) The rate increase does not apply to providers in federally qualified health centers, as Medicaid pays them using a different rate structure.

This evaluation measures changes in dentist enrollment and child and adult Medicaid utilization one year after the pilot’s launch.

WI Pilot Evaluation

Utilization Findings

  • Children: Dental Service use increased in the pilot counties by an average of 4 percentage points for children, only 2 percentage points higher on average than in non-pilot counties, and mostly driven by Brown County.  
  • Overall, even if all this increase was due to the pilot and not to FQHCs or other factors, the impact is still small.  If the pilot results were applied statewide, the portion of Medicaid children accessing dental care would increase from the current 43% to 47%, still leaving more than 278,000 children without care.
  • Racine county – the only pilot county with NO FQHCs -- had the lowest utilization increase of all four counties – 1.4 percentage points.
  • Adults: The rate of adults receiving any dental services increased by 5.1percentage points in pilot counties and 1.4 percentage points in non‐pilot counties. 
  • Even if all this increase was due to the pilot and not to other factors, the impact is still small.   If the pilot results were applied to the state’s 68 non-pilot counties, the portion of Medicaid adults accessing dental care would increase from 26.4% to 31.5%.
  • Racine county – the only pilot county with NO FQHCs -- had the second lowest utilization increase of all four counties – 1.2 percentage points.


Dental Provider Enrollment Findings

  • Provider enrollment in pilot counties increased by 33%, compared to 7% in non-pilot counties. 
  • Across the pilot counties, an additional 57 dentists enrolled in Medicaid; of them 46 treated Medicaid patients.
  • Given that only 32% of Wisconsin’s dentists were enrolled in Medicaid in 2015, if the pilot results were to be applied statewide, it would result in a 43% dentist enrollment rate. 

Dental Provider Enrollment Change







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[i] https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIGraphic_0217_1.pdf?la=en
[ii] Annual EPSDT Participation Report, ages 1-20  Fiscal Year: 2017, https://www.medicaid.gov/medicaid/benefits/epsdt/index.html
[iii] Gupta N, Yarbrough C, Vujicic M, Blatz A, Harrison B. Medicaid fee-for-service reimbursement rates for child and adult
dental care services for all states, 2016. Health Policy Institute Research Brief. American Dental Association. April 2017.
[iv] https://doa.wi.gov/DIR/Final_Ests_Co_2018.pdf