SIOUX FALLS, S.D. (KELO) — The rate of Medicaid reimbursement for dental services in South Dakota can further complicate access to dental care for some state residents.
South Dakota has about 472 practicing dentists in the state.
According to Paul Knecht, the executive director of the South Dakota Dental Association, and Dr. Michelle Scholdt, the chief dental officer for Horizon Health Care of Howard, many of those 472 dentists practice in non-rural areas.
Medicaid provides health insurance to at least 140,000 state residents who may be of lower-income including children. Some live in rural areas. Medicaid recipients may be elderly residents of nursing homes.
“Medicaid is a major challenge right now,” Knecht said. Fewer dentists are accepting patients with Medicaid insurance because the reimbursement is so low it doesn’t always cover costs, Knecht said.
The Health Policy Institute said the reimbursement rate for Medicaid for dental services is 62% of what private insurance would pay in South Dakota. For example, the mean charge for a periodic oral evaluation is $49 and Medicaid reimburses a dentist $29.71 for the service, according to the South Dakota Dental Association.
“Most offices are finding some way to limit seeing patients, they flat out aren’t taking any new patients,” Knecht said.
Dentists will share that they don’t want to turn down Medicaid patients but they can’t afford to take on new ones because of the cost, Knecht said.
About 58% of the state’s dentists accepted Medicaid or Children’s Health Insurance Program (CHIP) as of October, according to the Health Policy Institute. The number of accepted patients will vary by dentist and state.
The state’s dental association is advocating for HB 1103 which seeks to increase the state’s dental Medicaid reimbursement to more adequately meet costs.
“Our goal is to get 75% of what (private) insurance pays,” Knecht said. “It would keep most folks…able to cover costs.”
At 75% the reimbursement for a $49 periodic oral evaluation would be $36.75 instead of the existing $29.71.
Dr. Michelle Scholtz, the chief dental officer for Horizon Health Care of Howard, said an average of 17% of dental patients at all eight Horizon clinics are on Medicaid. Martin County, for example, has 51% of its patients on Medicaid.
Horizon serves a broad range of patients and also offers a sliding fee schedule so an increase in Medicaid reimbursement may not have a financial impact on the clinics, she said.
However if an increase in Medicaid reimbursement encourages more dentists to take on more Medicaid patients it would improve access for state residents and would lighten the load for Horizon dentists, Scholtz said.
Patients who are unable to find a dentist near them who accepts Medicaid patients may drive up to two hours to a Horizon clinic, Scholtz said.