More Money for Dental Care

For more than three decades, Medicaid has been woefully under funded by the State of Illinois. In fact, a few years ago the General Assembly even voted to reduce Medicaid dental funding by 7% to help balance the state’s budget on the backs of those who need the most help.

As a result, Illinois currently has one of the lowest reimbursement rates in the U.S. with only 46 cents on the dollar paid to dentists serving those on Medicaid. Dentists must absorb the remaining 54% of the costs for their Medicaid patients. These unfunded costs discourage most dentists from participating in the program, causing a serious shortage of dentists willing to treat Medicaid patients.

Illinois Rates vs. Rest of U.S.

The following chart represents Illinois Medicaid reimbursement rates to dentists and National Medicaid average reimbursement rates for a set of sample dental procedures. The last column shows where Illinois ranks with the rest of the nation in payment rates for dental Medicaid procedures.

Finally, readers should understand that the National Medicaid reimbursement rates represent only one-half of a typical average dentist's regular fee for these services. For example, in the case of an extraction, an average dentist's fee is about $110.

2006 Illinois State Dental Society National Medicaid Fee Survey

Raising the Reimbursement Rate Will Help Patients

In 2006, a federal court settlement forced Illinois to more than double the reimbursement rate for 4 preventive services for children. That increase alone resulted in improved quality of life for thousands of children because of better oral health care.

However, there is still a vast imbalance in payments for needed restorative services such as fillings, crowns and other major dental procedures. Based on the current enrollment, Bridge to Health Smiles proposes an additional $80 Million to the dental budget line to raise reimbursement so that dentists can provide improved access to dental treatment.

ISDS Position Paper: Further Expansion of Medicaid Program

Learn about the Bridge to Healthy Smiles Dental Clinics component.