Name of Practice: South Carolina Medicaid Dental Program (SC0701) Abstract
The State of South Carolina determined that participation by dentists in the State Medicaid program was insufficient prior to 2000. In response, the State Medicaid program increased fees to the 75th percentile of private-sector reimbursement rates and adopted a number of additional reforms designed to reduce administrative barriers to provider participation. The South Carolina Dental Association also began an outreach campaign of mailings and direct contacts to encourage dentists to participate in the Medicaid program. The program has significantly increased both the number of participating practitioners and the number of children treated in private dental offices.
The Problem The State of South Carolina determined that participation by dentists in the State Medicaid program was insufficient prior to 2000. Medicaid reimbursed dentists less than 50 percent of private-sector reimbursement rates. In 1999, only 26.1 percent of children received dental services through Medicaid, and only 619 dentists participated in the program. Discussion of Approach
Based on the findings of an independent contractor regarding the likely effects of increasing payment rates for Medicaid dental services, the South Carolina State legislature appropriated funds that enabled Medicaid to increase fees to the 75th percentile of private-sector reimbursement rates, effective January 2000. Once these fee increases took effect, the South Carolina Dental Association began an outreach campaign of mailings and direct contacts to encourage dentists to participate in the Medicaid program.
The State has also adopted a number of additional reforms designed to reduce administrative barriers and increase provider participation in Medicaid. The reforms consist of streamlining the prior authorization process, reimbursing for additional time needed to treat children with special health care needs, using standardized dental procedure codes and claim forms, establishing an intervention process to reduce patient broken appointments, and introducing electronic options to reduce billing errors and speed claims processing. Results In South Carolina, an increase in reimbursement rates and elimination of administrative barriers has dramatically expanded access to dental care. With the program changes implemented in January 2000, the number of dentists participating in Medicaid has increased from 619 in 1999 to 1,197 dentists in 2006. The percentage of enrolled children receiving any dental service has increased each year since 1999 and reached 38.5 percent in 2005. Further Information Contact: Shirley W. Carrington, R.D.H.
Supervisor, Dental Services, South Carolina Department of Health and Human Services
Division of Preventive and Ancillary Health Service
P.O. Box 8203
Columbia, SC 29202-8203
Tel: (803) 898-2568
Fax: (803) 255-8221
E-mail: carrings@dhhs.state.sc.us
This Profile has been posted to the CMS Medicaid/SCHIP Quality website for informational purposes only and does not convey CMS endorsement of the practice itself. The descriptive information supplied and the results reported in this Profile have been supplied by sources familiar with the practice but have not been independently validated by CMS.
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