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Getting Ahead: Medicaid and Dental Coverage

Posted Aug 30, 2023 1:46 PM
By Patricia Jones
 Alliance Community Task Force: Creating Opportunity

Earlier this summer a friend talked to me about the difficulty she was having finding a dentist who would see her and her children. The family is on Medicaid, and very few dentists in our area will see Medicaid patients. She’ll verify that—she’s called them all.

My friend contacted CAPWN, the Community Action Partnership of Western Nebraska, for assistance. She was required to fill out a gigantic packet of paperwork to prove eligibility, even though she has Medicaid coverage. When she submitted the packet, she learned she would need a separate packet for each member of her family, five packets in total. After those were turned in, she learned they would not serve new adults seeking assistance, only children.

CAPWN referred her to an office that provides emergency dental services for adults once a week beginning at 7:30 am. The line begins forming at 4:00 am. She arrived and joined the line at 4:30. After the office didn’t open, someone realized there was a sign on the door that said they were closed that week. She hasn’t been back.

She finally found a pediatric dentist in Scottsbluff who would see her children. However, she will have to go to Lincoln to get her cavities filled. Medicaid will help cover her gas expenses, but not her overnight room.

This month Flatwater Free Press ran a story about dental care for people on Medicaid. Destiny Herbers’ story—Disappearing dentists: For low-income Nebraskans, long drives, long lines, little help—was reprinted in several of the state’s newspapers. The full article can be found online at It includes several heartbreaking stories about people struggling to get dental care in our state. Many end up in emergency rooms when dental infections threaten their health.

Each year, fewer dentists treat Nebraska’s Medicaid patients. In the past five years, the number of dental providers treating Medicaid-eligible patients has decreased by 37%. Dentists say they are no longer accepting Medicaid-eligible patients because the state’s Medicaid reimbursement only covers about 39% of their bill, and their costs have risen tremendously in the last few years.

The problem is severe in western Nebraska. Only two dozen dentists west of Kearney have been paid for treating a Medicaid patient so far in 2023. Forty-three Nebraska counties have zero dentists helping low-income Nebraskans. In the Panhandle, there is one dentist in Chadron and a few in Scottsbluff who see Medicaid patients.

Nebraska’s Department of Health and Human Services handles reimbursement for Medicaid, following budget allocations from the Nebraska Legislature. This year their allocation was increased by 3%, but the same increase for next year was vetoed by Governor Pillen.

Sen. Lynne Walz of Fremont introduced a bill last January that would increase dental services reimbursement under the Medical Assistance Act by 25%. The increase would cost roughly $6 million. It would help cover the billing shortfall but still be less than most insurance coverages or private pay amounts dentists receive. The Legislature’s Health and Human Services Committee unanimously voted for LB 358, sending it to the full Legislature, but it has not yet been debated on the floor. The bill is on general file and will be brought up for debate during the 2024 session.

Currently the state caps an adult’s Medicaid dental coverage at $750 per year. New Medicaid plans with dental coverage will be available next year. In January, the $750 benefits cap will be removed, and there will be other changes to the structure of Medicaid’s dental coverage. Nebraska Medicaid is also changing reimbursements for dentures and wisdom teeth extraction to pay dentists for each step of treatment. Open enrollment for these plans begins in November, allowing patients to choose between three managed care organizations.

Meanwhile, people’s dental issues go untreated until they end up in hospital emergency rooms, costing the state so much more!