The question of whether to accept Medicaid is a hot topic among dentist across the country. For some the answer is easy: if the state covers limited or no procedures, there is not a lot of incentive to accept it. However, in areas where Medicaid covers a wider range of procedures (including restorative work and periodontal care), a provider’s stance on Medicaid normally boils down to political stance. Providers against government programs are less likely to accept Medicaid. Providers with a supportive or neutral stance on government programs usually consider Medicaid enrollment in one of three circumstances.

Financial

Many opponents of Medicaid argue that it simply does not pay well. The truth of this depends on where you practice. Medicaid reimbursements vary by state. In some states, such as Ohio, Medicaid reimbursements hover from 30-50% of UCR. However, in other states, like Indiana, Medicaid reimbursements are similar to PPO reimbursements (60 to 80% of UCR).

Dentists with thriving practices will understandably not see any value accepting Medicaid because available chair time could be reserved for new cash or insurance patients. However, dentist in struggling practices and new dentists can find significant opportunity increasing profitability and cash flow by accepting Medicaid.
Dentists in struggling practices often find themselves with a fair amount of chair time that, if filled, could help reverse negative financial trends. Accepting Medicaid patients and controlling traffic to non-peak cash and PPO appointment times can help improve office cash flow and grow the practice.

This same logic applies to the new dentist. Paying off student and practice loans can be overwhelming. Accepting Medicaid helps cover expenses, yields profits and shortens the lead time to grow the patient base between initial marketing and first patient response. Further, seeing Medicaid patients also helps a new dentist increase his or her clinical speed and exposure to a variety of dental conditions. Medicaid patients frequently demonstrate more dental health issues due to relative non-compliance (particularly with adults). Further, Medicaid patients do not have an out-of-pocket contribution for covered services. Thus, any dentist wishing to increase clinical speed, experience and confidence can effectively practice and improve on quadrant dentistry and higher procedural counts.

In general, any dentist filling only 60% of less of available chair time with PPO and cash patients may experience a marked increase in revenue accepting Medicaid – even despite lower reimbursements. Further, dentists are not required to accept Medicaid for life. Thus, accepting Medicaid can help you get over the hump if used as a financial strategy to boost production while you market and grow your cash and PPO patient base.

Location

Dentists experiencing declines in PPO and cash patient traffic despite similar or ramped up marketing efforts might be seeing this decline due to increased Medicaid enrollment in their area. In other words, former patients and potential new patients are no longer on PPO insurance plans and now meet requirements for Medicaid enrollment. This has been due to changing income thresholds for Medicaid enrollment, employers cancelling dental benefits to employees and sustained underemployment and unemployment in many areas. Many historically thriving practices in urban and rural areas may have not so much lost their patients as much as the patients have been lost them. In other words, may patients have changed to Medicaid and now seek dental care elsewhere.

Given this trend in many parts of the country, accepting Medicaid is an opportunity to keep an existing practice stable (or growing) in an effort to better serve the surrounding community and stay financially afloat.

Social Responsibility

The debate on accepting Medicaid often revolves around the financial benefits or detriments. However, accepting state funded plans may also be a reflection of dentist’s perspective on social responsibility. A dentist might feel that, regardless of location or financial detriment, accepting Medicaid is the right thing to do to better serve the underserved and promote greater overall dental health and wellness to all patients.

All in all, all three of these factors will be at play for any provider accepting Medicaid because it is likely that any dentist understanding the financial benefit of accepting Medicaid to increase cash flow can also develop a sense of pride helping those in his or her community in the greatest need of care.