1/6/2022 12:00:00 AM
This January, Minnesota is taking a major step toward addressing significant and longstanding gaps in dental care by raising state payment rates for dentists.
The rate increase is part of a $61 million dental package aimed at removing barriers that keep dentists from taking patients covered by Medical Assistance and MinnesotaCare. Included in Minnesota’s COVID-19 Recovery Budget signed into law by Governor Walz last year, the dental reforms include funding to raise the rates of reimbursement and implement other changes over the next four years. The Minnesota Department of Human Services increased the base dental reimbursement rate on Jan. 1.
Low-income Minnesotans with Medical Assistance and MinnesotaCare are more likely to have dental disease than Minnesotans with employer-sponsored insurance, and they also have a harder time getting dental care. For example, over 60% of Minnesota children living in poverty did not see a dentist in 2019.
“Our goal is to create more options for Minnesotans who need dental care,” said Human Services Commissioner Jodi Harpstead. “By supporting dentists with fair rates, this investment will make it easier for people in public health care programs to get the dental care that’s so important to their daily lives and overall well-being. The strong support and tireless work of our legislative committee chairs in both the House and Senate made this change possible.”
Under the old payment structure, reimbursements varied based on multiple factors, including the patient’s age and the provider’s location. Low payment rates set more than 30 years ago kept many dental providers from serving public program patients.
The new rates are simpler and more efficient, with all dentists receiving the same rates for the same services for both Medical Assistance and MinnesotaCare. All dentists are expected to receive an overall increase in payments. For some services, payments may increase up to 98%.
DHS also will add coverage of non-surgical treatment for periodontal disease, the leading cause of adult tooth loss.
Managed care rates for dental care will have to at least match DHS’ fee-for-service rates. Managed care organizations will be required to give dental providers their fee schedules when asked, so that dentists better understand how they are paid.
With the new rate structure, health plans will also have to meet benchmarks to ensure that more people in public health care programs receive dental care. Starting in 2022, the goal will be an annual dental visit for at least 45% of enrollees. The participation rate will rise to 55% in 2024. If any managed care organization is unable to meet that benchmark, DHS plans to carve out the dental benefit and administer dental coverage directly for all public program enrollees.
How to find dental care if you have Medical Assistance or MinnesotaCare:
To find out if you are eligible and to apply for Medical Assistance or MinnesotaCare:
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