During the Texas Health and Human Services Commission (HHSC) public hearing on November 12, which focused on the proposed adjustments to the Medicaid dental fee schedule, a total of eleven dental professionals, including a key representative from the Texas Dental Association, provided their testimonies, either in person or through virtual platforms. These professionals voiced pressing concerns, emphasizing that the proposed rate changes would not adequately support providers in maintaining their high-quality care services, especially in light of significant cost increases after a staggering 17-year period of stagnant rates.
The core issue at stake is the disparity in proposed rate adjustments; less frequently utilized codes received increases, while those codes that are in high demand did not see any changes. Notably, the dental code D0145 faces a drastic reduction, plummeting by an alarming 62%, from $142.07 to just $54.58.
Providers financing the Medicaid program
One dental provider expressed deep concern, stating that Medicaid dentists now find themselves not only compromising the quality of care they provide but are also, quite troublingly, financing the state’s dental Medicaid program out of their own pockets.
Testimony probably a first
This testimony is likely unprecedented in the state; it is almost certain that this marks the first occasion that dental providers have come before an HHSC Provider Finance hearing. The dedication demonstrated by so many professionals taking time from their busy schedules underscores the urgent need for a meaningful rate adjustment.
Hearing resources provided
The Texas Dental Medicaid Reform (TDMR) coalition has edited and shared the hearing video on the Provider Finance website, emphasizing the impactful testimonies of dentists, which can now be accessed on our YouTube channel. Additionally, a machine transcription of the provided testimony, albeit imperfect, is available for download below.
TDMR also submitted comprehensive comments to Provider Finance on November 12, with a PDF copy of the commentary included below for further reference.
Quotes from testimony
“The last fee increase we had was in 2007… A dollar in 2007 is now $1.55 when you look at the inflation index as well.”
“We’re unable to compete with Chick-fil-A and other businesses for [staff], and we’re unable to pay our staff the proper amounts.”
“We are seeing offices on the ground going out of business because they are no longer able to compete and maintain their business with the fees where they are.”
“We’ve seen a 25% exit of dental assisting staff and hygienists from dentistry, both in Texas and across the country.”
“Pediatric dentists report they are paying 20% more for the cost of supplies and labor than they were paying just five years ago.”
“Every day, our organization hears from frustrated providers who are debating the heartbreaking decision of leaving the Medicaid program.”
“We have endured an astonishing 17 years of zero increase in reimbursement rates.”
“A significant amount of my patients travel 150 to 200 miles to see me because there are no local providers willing or able to treat them.”
“Restorative treatment has become a huge burden… I’m getting paid in 2007 fees that are completely insufficient.”
“I’ve had to take on a second position outside my practice… essentially subsidizing the state’s healthcare costs by working for free.”
“TDA is advocating for a $250 million annual increase to restore Medicaid dental fees to 2007 levels, adjusted for inflation.”
“Meaningful reimbursement improvements require the Texas Legislature to increase funding for Medicaid dental services.”
“Low fees drive low quality. The lower the fees, the lower the standard of care.”
“Preventive care is important… Yet denial of claims or restrictions of service make it harder to deliver holistic, comprehensive care.”
“While we appreciate the move to make adjustments, the adjustment needs to be significant to actually match current market rates.”
“In 2007, Health and Human Services’ budget was around $210 billion. It’s now $320 billion… yet dental reimbursements have gone down.”
“You spend a dollar on prevention, you’re going to save $2 down the road in treatment.”
We sincerely hope these voices will be heard for the good of the Medicaid-eligible children in Texas.
How has the increase in operational costs affected pediatric dental practices, according to Dr. Johnson?
**Interview with Dr. Emily Johnson, a Pediatric Dentist and Advocate for Medicaid Reform**
**Editor:** Thank you for joining us today, Dr. Johnson. You were among the dental professionals who testified at the recent public hearing regarding the proposed adjustments to the Medicaid dental fee schedule. Can you summarize your main concerns about these proposed changes?
**Dr. Johnson:** Thank you for having me. My primary concern is that the proposed rate changes simply do not reflect the realities we’re facing in our practices. After 17 years without a significant fee increase, the dental codes that are high-demand services, particularly D0145, are facing drastic cuts—62% in this case. This creates a situation where dentists like myself are not only unable to provide quality care but are effectively subsidizing the state’s Medicaid program from our own pockets.
**Editor:** That is alarming. Can you provide some context around why these changes are particularly damaging now?
**Dr. Johnson:** Certainly. Over the last few years, we’ve seen a significant increase in operational costs—supplies, staffing, everything has risen sharply. To give you an example, pediatric dentists are now paying 20% more for labor and supplies than we were just five years ago. Yet, the proposed changes seem to disregard the realities of inflation and cost increases entirely.
**Editor:** The hearing seemed to mark a significant moment in advocating for dental professionals. Why do you think this testimony was unprecedented?
**Dr. Johnson:** It’s likely the first time dental providers have come forward to voice such clear concerns at an HHSC Provider Finance hearing. The fact that so many dentists took time out of their busy schedules to testify shows just how urgent this issue is. We are all dedicated to ensuring that our patients receive the care they need, but many of us are reaching a breaking point.
**Editor:** You mentioned in your testimony that it’s becoming increasingly difficult to attract and retain staff. Can you elaborate on that?
**Dr. Johnson:** Absolutely. We’re losing skilled dental assistants and hygienists at an alarming rate—around 25% have exited the field in Texas alone. We simply can’t compete with other sectors, like fast food, that offer better wages and working conditions. This not only affects us as providers but ultimately impacts the care we can provide to our patients.
**Editor:** What are the next steps for you and your colleagues following this hearing?
**Dr. Johnson:** We’re committed to continuing our advocacy efforts. The Texas Dental Medicaid Reform coalition is working on further pushing for meaningful rate adjustments and has submitted comprehensive comments to Provider Finance. We will also be sharing our testimonies widely to raise awareness of these critical issues and hopefully drive change.
**Editor:** Thank you for sharing your insights, Dr. Johnson. It’s clear that the dental community in Texas is facing a significant challenge, and we hope to see positive outcomes from these discussions.
**Dr. Johnson:** Thank you for covering this important topic. Our patients deserve the best care possible, and we need the support to make that happen.