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Oregon dentists don’t like dealing with the Oregon Health Plan. Depending on the region, 55% to 70% of dentists say they don’t accept patients on Medicaid at all, according to the Oregon Health Authority. That makes finding a dentist a problem for low-income Oregonians, particularly those who live in rural areas.
The agency is trying to change that—but first, it needs to understand why it’s happening.
Jon McElfresh, of OHA, led a team of researchers to do just that. With funding from a $1.6 million federal grant, they interviewed OHA staff who administer the state’s Medicaid program, the Oregon Health Plan. Now, they’ve compiled the results. What they found was a gaping disconnect between theory and reality.
State officials told McElfresh’s team that enrolling in OHP and obtaining reimbursements was a “fairly straightforward and clear.” Unfortunately, McElfresh said in a webinar recorded Oct. 9 and distributed by OHA, “this narrative ran counter to the experience described by dental practices.”
Here’s what those dentists said, according to McElfresh:
The process to file Medicaid insurance claims was tedious. Coverage was insufficient for many common dental procedures, like wisdom teeth removals or dentures. And, the state didn’t do a good job communicating what was covered and what wasn’t.
“Often, providers were not aware in a change in the covered services until they had filed a Medicaid claim and the claim was denied,” McElfresh said.
His team issued a series of recommendations, from increasing Medicaid reimbursement rates to “implementing a communication and outreach plan” in order to “reduce misconceptions about OHP.”