Microsoft Word - HPI Research Brief - Medicaid Fee-For-Service Reimbursement Rates for Child and Adult Dental Care Services for

April 2017

Medicaid Fee-For-Service Reimbursement

Rates for Child and Adult Dental Care

Services for all States, 2016

Authors: Niodita Gupta, M.D., M.P.H., Ph.D.; Cassandra Yarbrough,

M.P.P.; Marko Vujicic, Ph.D.; Andrew Blatz, M.S.; Brittany Harrison, M.A.

Introduction

Low-income children and adults are subject to different dental safety nets. States are

required to provide dental benefits to children, who are covered by Medicaid and the

Children’s Health Insurance Program (CHIP), but providing adult dental benefits is optional.

Increased enrollment in Medicaid and CHIP led to a historic low of 11 percent of children

lacking dental benefits in 2014, the most recent year data are available.

There has also

been a steady increase in dental care utilization among children enrolled in Medicaid and

CHIP over the past fifteen years.

Low-income adults have not experienced similar gains. In

2014, the latest year for which we have data since Medicaid expansion under the Affordable

Care Act, 54 percent of Medicaid-enrolled adults lived in states that provide adult dental

benefits in their Medicaid programs.

However, 35.2 percent of adults in the U.S. do not

have any form of dental coverage.

A key issue for Medicaid is having a sufficient number of providers willing to participate.

Research shows that a variety of factors limit the number of dentists that accept Medicaid,

including high rates of cancelled appointments among Medicaid enrollees, low

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Key Messages

 Wisconsin, Washington and California had the lowest Medicaid reimbursement rates for

both adult and child dental care services among states that provide dental services via

fee-for-service.

 There is considerable variation across states in Medicaid fee-for-service reimbursement

rates.

Research Brief

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reimbursement rates, low compliance with

recommended treatment, and cumbersome

administrative procedures.

In terms of reimbursement

rates, numerous studies illustrate a statistically

significant positive relationship between Medicaid

reimbursement rates and dental care utilization among

publicly insured children

5-7

as well as dentist

participation in Medicaid.

6,8

In this research brief, we analyze Medicaid

reimbursement rates for dental care services in all

states and the District of Columbia for 2016.

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Results

Table 1 describes Medicaid fee-for-service (FFS)

reimbursement relative to fees charged by dentists and

private dental insurance reimbursement. Medicaid FFS

reimbursement, on average, is 49.4 percent of fees

charged by dentists for children and 37.2 percent for

adults. Medicaid FFS reimbursement, on average, is

61.8 percent of private dental insurance

reimbursement for children and 46.1 percent for adults.

Private dental insurance reimbursement is, on

average, 80.5 percent of fees charged by dentists for

children and 78.6 percent for adults.

Figure 1 illustrates Medicaid FFS reimbursement as a

percentage of fees charged by dentists for child dental

services. Delaware (82.3 percent), Alaska (65.6

percent), Arkansas (63.0 percent), North Dakota (62.4

percent), and South Dakota (61.1 percent) have the

highest Medicaid FFS reimbursement rates relative to

fees charged by dentists while California (30.8

percent), Wisconsin (32.1 percent), Washington (32.5

percent), Iowa (40.8 percent), and Hawaii (41.6

percent) have the lowest.

Figure 2 illustrates Medicaid FFS reimbursement as a

percentage of private dental insurance reimbursement

for child dental services. Delaware (98.4 percent),

Maryland (79.3 percent), Utah (75.3 percent),

Arkansas (75.2 percent), and Massachusetts (74.1

percent) have the highest Medicaid FFS

reimbursement rates relative to private dental

insurance reimbursement rates while Wisconsin (36.4

percent), California (38.7 percent), Washington (40.4

percent), Maine (49.8 percent), and Iowa (49.8

percent) have the lowest.

Figure 3 illustrates private dental insurance

reimbursement as a percentage of fees charged by

dentists for child dental services. Alaska (93.0

percent), Wyoming (92.7 percent), South Dakota (92.4

percent), Oregon (92.4 percent), and North Dakota

(91.8 percent) have the highest rates relative to fees

charged by dentists while New York (55.5 percent),

Maryland (68.8 percent), Pennsylvania (70.0 percent),

Utah (71.5 percent), and Kentucky (72.7 percent) have

the lowest.

Figure 4 illustrates Medicaid FFS reimbursement as a

percentage of fees charged by dentists for adult dental

services in states with extensive adult dental benefits

within their Medicaid programs. Alaska (59.4 percent),

North Dakota (59.0 percent), Montana (56.9 percent),

North Carolina (43.7 percent), and Iowa (40.4 percent)

have the highest Medicaid FFS reimbursement rates

relative to fees charged by dentists while Rhode Island

(25.5 percent), Washington (25.8 percent), Wisconsin

(27.1 percent), Connecticut (27.3 percent), and

California (34.3 percent) have the lowest.

Figure 5 illustrates Medicaid FFS reimbursement as a

percentage of private dental insurance reimbursement

for adult dental services in states with extensive adult

dental benefits within their Medicaid programs. North

Dakota (66.5 percent), Alaska (63.2 percent), Montana

(62.0 percent), North Carolina (52.9 percent), and

Massachusetts (49.4 percent) have the highest

Medicaid FFS reimbursement rates relative to private

dental insurance reimbursement rates while Wisconsin

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(31.4 percent), Washington (32.4 percent), Rhode

Island (33.7 percent), Connecticut (34.2 percent), and

California (43.8 percent) have the lowest.

Figure 6 replicates Figure 3, but for adult dental

services. Wyoming (94.3 percent), Alaska (94.0

percent), Montana (91.7 percent), South Dakota (91.4

percent), and North Dakota (88.7 percent) have the

highest private dental insurance reimbursement rates

relative to fees charged by dentists while New York

(51.4 percent), Maryland (66.0 percent), Pennsylvania

(67.2 percent), District of Columbia (67.7 percent), and

Utah (70.1 percent) have the lowest.

Discussion

In our view, we have the most up-to-date,

comprehensive, and scientifically sound analysis of

Medicaid FFS reimbursement for dental care services

in the United States. As noted in our methods section,

our analysis has several important shortcomings,

which all stem from data limitations. Most notably, for

states with managed care programs for Medicaid

dental care services, there is no publicly available

source of data for reimbursement rates. The managed

care “data void” continues to be a limiting factor for

researchers, and we continue to urge state

policymakers to push for data transparency.

While our analysis in this research brief is descriptive,

there are some important conclusions that can be

drawn. First, the lowest Medicaid FFS reimbursement

for both adult and child dental care services tend to be

found in the same states: Wisconsin, Washington and

California. Second, there is considerable variation

across states in Medicaid FFS reimbursement rates.

Third, there is considerable variation across states in

the private dental insurance “discount” rate.

Medicaid reimbursement rates, in part, determine the

success of Medicaid programs. Research has shown

that adjusting Medicaid payment rates closer to

“market” levels in conjunction with other reforms has a

significantly positive effect on access to dental care.

For example, the Medicaid program in Connecticut

increased dental reimbursement rates to the 70th

percentile of private dental insurance rates in mid-2008

and implemented a case management program to

reduce appointment cancellations. This led to a

considerable increase in provider participation, access

to dental care, and dental care use among Medicaid-

enrolled children.

Maryland’s Medicaid program

increased dental care reimbursement, carved Medicaid

dental services out of managed care,

increased the

Medicaid dental provider network, improved customer

services for providers and patients, streamlined

credentialing, and created a missed appointment

tracker over the past decade.

During this time,

Maryland has seen one of the largest increases in

dental care use among Medicaid-enrolled children of

any state.

11,12

The Texas Medicaid program increased

dental reimbursement by more than 50 percent in

September 2007, implemented loan forgiveness

programs for dentists who agreed to practice in

underserved areas, and allocated more funds to dental

clinics in underserved communities.

By 2010, dental

care use among Medicaid-enrolled children in Texas

had increased so much that it actually exceeded the

rate among children with commercial dental

insurance.

The experiences of Connecticut, Maryland

and Texas illustrate the impact of “enabling conditions”

— reimbursement closer to market rates, patient and

provider outreach, streamlined administrative

procedures, patient navigators, enhanced incentives in

underserved areas — on provider participation and,

ultimately, access to dental care.

The Health Policy Institute is pursuing additional

research based on the data summarized in this

research brief. We aim to answer questions about the

impact of Medicaid FFS reimbursement rates on

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dentist participation and dental care use among

Medicaid enrollees. We will also compare Medicaid

reimbursement rates provided to dentists to those

provided to physicians.

Table 1: Summary of Reimbursement Rates, 2016

Medicaid fee-for-service

reimbursement relative to fees

charged by dentists

Medicaid fee-for-service

reimbursement relative to private

dental insurance reimbursement

Private dental insurance

reimbursement relative

to fees charged by

dentists

Child dental

services

49.4% 61.8% 80.5%

Adult dental

services

37.2% 46.1% 78.6%

Source: HPI analysis of Medicaid fee-for-service reimbursement data collected from state Medicaid agencies, FAIR Health, and

Truven Health MarketScan® Research Database. Note: For child dental services, this table provides the average across 50 states and

Washington, D.C. For adult dental services, this table provides the average across 16 states with an extensive Medicaid adult dental

benefit for the Medicaid FFS reimbursement relative to fees charged by dentists and Medicaid FFS reimbursement relative to private

dental insurance reimbursement. For adult dental services, this tables provides the average across 50 states and Washington, D.C. for

the private dental insurance reimbursement relative to fees charged by dentists.

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Figure 1: Medicaid Fee-For-Service Reimbursement as a Percentage of Fees Charged by Dentists, Child

Dental Services, 2016

Source: HPI analysis of Medicaid fee-for-service reimbursement data collected from state Medicaid agencies and FAIR Health. FFS

versus managed care designation primarily based on analysis by the Kaiser Commission on Medicaid and the Uninsured. Note: Some

states enroll only certain segments of Medicaid enrollees in managed care programs, or provide certain services through managed

care programs. These states are denoted by *.

30.7%

31.1%

31.3%

31.4%

34.6%

35.6%

36.8%

39.3%

42.1%

43.2%

44.4%

45.3%

46.6%

47.4%

48.5%

48.8%

54.1%

55.6%

55.8%

60.7%

65.3%

67.4%

77.9%

30.8%

32.1%

32.5%

40.8%

41.6%

43.6%

44.6%

45.3%

45.8%

46.2%

46.4%

46.5%

49.9%

51.0%

51.7%

53.8%

54.5%

56.2%

57.3%

58.4%

59.4%

59.7%

60.7%

61.1%

62.4%

63.0%

65.6%

82.3%

0% 20% 40% 60% 80% 100%

WI*

IN*

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Figure 2: Medicaid Fee-For-Service Reimbursement as a Percentage of Private Dental Insurance

Reimbursement, Child Dental Services, 2016

Source: HPI analysis of Medicaid fee-for-service reimbursement data collected from state Medicaid agencies and Truven Health

MarketScan® Research Database. FFS versus managed care designation primarily based on analysis by the Kaiser Commission on

Medicaid and the Uninsured. Note: Some states enroll only certain segments of Medicaid enrollees in managed care programs, or

provide only certain services through managed care programs. These states are denoted by *.

37.5%

38.2%

38.3%

40.8%

46.6%

46.8%

50.0%

52.5%

55.7%

58.9%

59.3%

60.8%

62.2%

64.8%

71.0%

72.1%

73.8%

79.9%

82.3%

87.7%

85.1%

107.1%

36.4%

38.7%

40.4%

49.8%

50.3%

51.7%

52.4%

56.0%

56.6%

57.8%

59.0%

62.4%

63.1%

63.3%

64.4%

66.1%

67.9%

69.2%

70.1%

70.5%

72.4%

72.5%

74.1%

75.2%

75.3%

79.3%

98.4%

0% 20% 40% 60% 80% 100% 120%

WI*

IN*

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Figure 3: Private Dental Insurance Reimbursement as a Percentage of Fees Charged by Dentists, Child

Dental Services, 2016

Source: HPI analysis of Truven Health MarketScan® Research Database and FAIR Health.

55.5%

68.8%

70.0%

71.5%

72.7%

73.2%

73.3%

73.4%

73.7%

73.8%

74.4%

76.3%

76.9%

77.1%

77.5%

78.4%

78.6%

78.7%

79.0%

79.2%

79.4%

79.5%

79.8%

80.0%

80.1%

80.3%

80.4%

80.5%

81.2%

81.3%

82.0%

83.4%

83.6%

83.8%

83.9%

86.6%

87.5%

88.0%

88.3%

89.6%

90.8%

91.0%

91.8%

92.4%

92.7%

93.0%

0% 20% 40% 60% 80% 100%

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Figure 4: Medicaid Fee-For-Service Reimbursement as a Percentage of Fees Charged by Dentists, Adult

Dental Services, 2016

Source: HPI analysis of Medicaid fee-for-service reimbursement data collected from state Medicaid agencies and FAIR Health. FFS

versus managed care designation primarily based on analysis by the Kaiser Commission on Medicaid and the Uninsured. Note: Some

states enroll only certain segments of Medicaid enrollees in managed care programs, or provide only certain services through

managed care programs. These states are denoted by *.

Figure 5: Medicaid Fee-For-Service Reimbursement as a Percentage of Private Dental Insurance

Reimbursement, Adult Dental Services, 2016

Source: HPI analysis of Medicaid fee-for-service reimbursement data collected from state Medicaid agencies and Truven Health

MarketScan® Research Database. FFS versus managed care designation primarily based on analysis by the Kaiser Commission on

Medicaid and the Uninsured. Note: Some states enroll only certain segments of Medicaid enrollees in managed care programs, or

provide only certain services through managed care programs. These states are denoted by *.

16.5%

29.4%

34.0%

34.7%

42.5%

25.5%

25.8%

27.1%

27.3%

34.3%

38.7%

40.4%

43.7%

56.9%

59.0%

59.4%

0% 20% 40% 60% 80% 100%

WI*

MA*

21.6%

33.2%

45.7%

52.9%

66.2%

31.4%

32.4%

33.7%

34.2%

43.8%

49.1%

49.4%

52.9%

62.0%

63.2%

66.5%

0% 20% 40% 60% 80% 100%

WI*

MA*

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Figure 6: Private Dental Insurance Reimbursement as a Percentage of Fees Charged by Dentists, Adult

Dental Services, 2016

Source: HPI analysis of Truven Health MarketScan® Research Database and FAIR Health.

51.4%

66.0%

67.2%

67.7%

70.1%

70.9%

71.6%

72.0%

72.4%

72.6%

73.5%

74.0%

74.9%

75.7%

76.0%

76.4%

76.5%

77.2%

77.7%

77.9%

78.0%

78.3%

78.4%

79.7%

79.9%

80.3%

80.4%

80.6%

81.1%

81.3%

82.2%

82.6%

86.2%

86.8%

87.3%

87.6%

88.5%

88.7%

91.4%

91.7%

94.0%

94.3%

0% 20% 40% 60% 80% 100%

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Table 2: List of Procedures and Corresponding Weights for Child Dental Services

CDT Procedure Code Weight

D0120 - Periodic oral evaluation - established patient 25.614%

D1120 - Prophylaxis - child 25.125%

D1110 - Prophylaxis - adult 14.113%

D1208 - Topical application of fluoride – excluding varnish 9.010%

D1351 - Sealant - per tooth 7.280%

D0272 - Bitewings - two radiographic images 6.340%

D0274 - Bitewings - four radiographic images 5.561%

D1206 - Topical application of fluoride varnish 3.234%

D0220 - Intraoral - periapical first radiographic image 2.218%

D0230 - Intraoral - periapical each additional radiographic image 1.505%

Source: HPI analysis of Truven Health MarketScan® Research Database.

Table 3: List of Procedures and Corresponding Weights for Adult Dental Services

CDT Procedure Code Weight

D1110 - Prophylaxis - adult 36.856%

D0120 - Periodic oral evaluation – established patient 20.065%

D0274 - Bitewings – four radiographic images 9.751%

D2392 - Resin-based composite – two surfaces, posterior 8.469%

D4910 - Periodontal maintenance 6.347%

D2391 - Resin-based composite – one surface, posterior 6.108%

D0140 - Limited oral evaluation – problem focused 3.777%

D0150 - Comprehensive oral evaluation – new or established patient 3.578%

D0220 - Intraoral - periapical first radiographic image 3.535%

D0230 - Intraoral – periapical each additional radiographic image 1.515%

Source: HPI analysis of Truven Health MarketScan® Research Database.

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Data & Methods

We collected 2016 Medicaid fee-for-service (FFS)

reimbursement rate data from state Medicaid program

webpages on March 18 and 20, 2017. For some of the

states that had updated their reimbursement rates for

2017, we used 2017 reimbursement rate data. Data for

child dental care services were collected for all 50

states and D.C. Data for adult dental care services

were collected for states that provided extensive dental

benefits to Medicaid-enrolled adults in 2016 (AK, CA,

CT, IA, MA, MT,NJ, NM, NY, NC, ND, OH, OR, RI,

WA, WI).

Many state Medicaid programs contract with a

managed care provider and do not pay dental care

providers via the publicly available FFS schedule. To

our knowledge, managed care reimbursement rate

data are not publicly available in any state and we

were not able to include such data in our analysis. We

focused solely on Medicaid FFS reimbursement rates,

understanding that in many states, this is not how most

dental care is reimbursed. According to the Kaiser

Commission on Medicaid and the Uninsured, Medicaid

programs in 23 states contracted with managed care

organizations for children’s dental care services (AZ,

CO, DC, FL, GA, IL, KS, KY, MI, MN, MS, MO, NV, NJ,

NM, NY, OH, OR, PA, RI, TN, TX, WV) and in 15

states for adult dental care services (AZ, CO, DC, FL,

IL, KY, MN, MS, MO, NJ, NM, NY, OH, OR, PA) in

2015.

In some cases, however, certain dental care

services are covered under a managed care program

while others are covered under FFS. Two states have

such arrangement for dental services for children (IN,

WI) and four states have such arrangement for dental

services for adults (IN, MA, MI, WI).

The lack of

transparent, publicly available data on reimbursement

rates within managed care programs presented a

significant limitation to our analysis. While Medicaid

FFS reimbursement rates are intended to be a

benchmark or guide for managed care organizations, it

is unclear whether this happens in practice. As a result,

we distinguish FFS states and managed care states in

our analysis.

We obtained private dental insurance reimbursement

rate data for each state and D.C. for 2015 from the

Truven Health MarketScan® Research Databases

(Truven). Truven contains medical and dental claims

and enrollment data from beneficiaries of large

employer medical and dental plans across the United

States, including claims from a variety of FFS,

preferred provider organization (PPO), and capitated

dental plans. Truven includes the amount paid to the

dentist for various procedures as well as the amount

paid out of pocket by the beneficiary. In other words, it

includes total payments to dentists. In 2015, there were

8.8 million people with private dental insurance

included in Truven. Based on the latest data from the

Medical Expenditure Panel Survey (MEPS),

estimate that Truven captures about 5.4 percent of the

private dental insurance market in the United States.

Because our Medicaid reimbursement rate data are for

2016, we inflated the Truven reimbursement rate data

to 2016 levels using the all-items Consumer Price

Index.

We obtained data on fees charged by dentists for each

state and D.C. for 2015 from the FAIR Health Dental

Benchmark Module (FAIR Health).

FAIR Health

provides data on the non-discounted amount charged

by dentists for various procedures before network

discounts are applied. In 2015, there were 54.7 million

people with private dental insurance included in FAIR

Health.

Based on the latest MEPS data,

estimate that FAIR Health captures about 33.5 percent

of the private dental insurance market in the United

States. We also inflated the 2015 FAIR Health charges

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data to 2016 levels using the all-items Consumer Price

Index.

We constructed two measures of Medicaid FFS

reimbursement: (1) Medicaid FFS reimbursement rates

relative to the fees charged by dentists, and (2)

Medicaid FFS reimbursement rates relative to

reimbursement rates through private dental insurance.

These measures express Medicaid FFS

reimbursement relative to “market” rates. We also

constructed a measure of private dental insurance

reimbursement relative to the fees charged by dentists.

Nationwide, 97.6 percent of dentists report accepting

some form of private dental insurance and, on

average, such payments account for 41.5 percent of

gross billings in dental offices.

Private dental

insurance is a significant source of dental care

financing in the U.S., accounting for 47 percent of total

dental care expenditures in 2015.

The analysis for child dental care services is based on

the top ten most common procedures among children

with private dental insurance as identified in previous

research (see Table 2).

These ten procedures

accounted for 40.3 percent of the total of billings and

74.2 percent of the total number of procedures among

children with private dental insurance in 2015 within

the Truven data set. We consider children ages 0 to

18.

The analysis for adult dental care services is based on

the top ten most common procedures among adults

with private dental insurance as identified in previous

research (see Table 3).

These ten procedures

accounted for 39.2 percent of the total billings and 73.7

percent of the total number of procedures among

adults with private dental insurance in 2015 within the

Truven data set. We consider adults ages 19 to 64.

We computed the weighted average of the

reimbursement rates for the ten most common

procedures to create an index. The weights for each of

the ten procedures were calculated as the share of

total billings represented by each procedure. The

weights were calculated separately for child dental

care services and adult dental care services. The

weights are summarized in Tables 2 and 3. The

Medicaid FFS reimbursement rate index, the fees

charged by dentists index, and the private dental

insurance reimbursement rate index were constructed

using this common weighting scheme.

We divided the Medicaid FFS reimbursement index by

the fees charged by dentist index to calculate our first

outcome of interest: Medicaid reimbursement relative

to fees charged by dentists. We divided the Medicaid

FFS reimbursement index by the private dental

insurance reimbursement index to calculate our

second outcome of interest: Medicaid reimbursement

relative to private dental insurance reimbursement. We

also calculated private dental insurance reimbursement

relative to fees charged by dentists to estimate the

average “discount” rate off of dentist charges. We did

this separately for child and adult dental care services.

It is important to note that previous research shows no

substantial differences in results if the indices were

created by weighting reimbursement rates and charges

by their share of the total number of procedures

performed versus total billings.

There are several limitations to our analysis. First, as

noted, our Medicaid reimbursement rates are based on

FFS schedules. In some states, these are less relevant

because most care is delivered through managed care

arrangements. To account for this, we present

managed care states separately from FFS states,

according to the best publicly available information.

Second, our reimbursement indices are based on a

limited set of procedures. While ideally all procedures

would be included, this is not feasible given our interest

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in comparability across states. Because our procedure

lists capture three quarters of the total volume of dental

procedures, we feel we struck an appropriate balance

between comprehensiveness and feasibility.

Third, our weighting scheme is based on the mix of

dental care services for adults and children with private

dental insurance. There are likely differences in the

relevant importance of various procedures between the

Medicaid and privately insured populations.

25,26

Unfortunately, we do not have access to Medicaid

claims data in order to assess these differences.

However, several Medicaid colleagues and

researchers have indicated the procedure mix within

Medicaid and privately insured populations will be

comparable, particularly for children. Moreover, our list

of the top ten most common procedures is quite

comparable to published research focusing on

Medicaid populations.

27-29

Again, we feel we struck an

appropriate balance between feasibility and complexity

in our analysis.

Fourth, we were not able to distinguish PPO, HMO,

and other types of plans within our private dental

insurance reimbursement rate data. It is likely that

reimbursement rates to dentists differ systematically

across these types of private dental insurance plans.

We have no way of assessing this with the Truven

data, and we assume simply that the mix of PPO,

HMO, and other types of plans are representative of

the market. According to the National Association of

Dental Plans, in 2015, PPO plans accounted for 82

percent of the private dental insurance market and

HMO plans accounted for 7 percent.

Fifth, there may be some inconsistency in how dentists

submit charges data on private dental insurance

claims, which could lead to measurement error. FAIR

Health’s dental module provides fee data based on

“the non-discounted fees charged by providers before

network discounts are applied.” In theory, this should

be true, non-discounted fees. However, based on

provider feedback, providers often submit the fees they

expect to be paid rather than their true, non-discounted

fees. We have no basis to evaluate this empirically and

simply raise this as a potential limitation. An alternative

data source for market fees would be HPI’s annual fee

survey that collects full, undiscounted fees from a

national sample of dentists.

We did not use these

data because they are not available at the state level.

Disclaimer

Research for this article is based upon the data

compiled and maintained by FAIR Health, Inc. and

Truven Health Analytics™. HPI is solely responsible for

the research and conclusions reflected in this article.

FAIR Health, Inc. and Truven Health Analytics™ are

not responsible for the conduct of the research or for

any of the opinions expressed in this article.

This Research Brief was published by the American Dental Association’s Health Policy Institute.

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Research Brief. American Dental Association. October 2016. Available from:

http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1016_2.pdf.

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Research Brie

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orthodontic procedure D8670 was the 8th most common procedure. However, it was excluded from our analysis due to

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Appendix 1. Medi-Cal Dental Services Rate Review. July 2016. California Department of Health Care Services.

Appendix B. House Bill 15. Frew Expenditure Plan. September 2007. The State of Texas Health and Human Services

Commission.

Appendix D. 2008 National Dental Summary. January 2009. Centers for Medicare & Medicaid Services.

2016 National Association of Dental Plans Benefits Report-Enrollment. September 2016. NADP. Available from

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2016 Survey of Dental Fees. Health Policy Institute. American Dental Association.

Suggested Citation

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. Available from: http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0417_1.pdf.