Wisconsin’s dental Medicaid and BadgerCare programs are grossly underfunded, which denies patients necessary economic purchasing power. Increasing access depends on additional financial investment by the state, because coverage alone does not equal care.

• Dental Medicaid is not considered mandatory by the federal government. The state decides: type of dental procedures allowed/covered; who receives coverage; and amount of reimbursement for services provided to MA patients. Once the state decides coverage and reimbursement details, the federal government covers 60 percent and the state generally covers 40 percent.

• Wisconsin is one of only a few states offering comprehensive dental care coverage to the adult MA population. Adults, rather than children, are most likely to suffer from serious, debilitating dental infections that are costly to treat, contribute to missed work days or unemployment and result in repeated and costly trips to hospital emergency rooms.

• The state reimburses about 30-35 cents for every $1 of services provided in a private dental practice NOT including the dentist's salary. Compare to Federally Qualified Health Centers that are reimbursed at cost for dental services or about twice the amount paid to private dental practices (view data). In addition, FQHC buildings and equipment are frequently paid for by the government – a substantial advantage over private practitioners.

• A Wisconsin work force report released in January 2010 details the tremendous increase in the state’s MA population. About 1 million low-income individuals, or 20 percent of Wisconsin residents, are beneficiaries of MA coverage in a 12-month period. The number of MA individuals who where continuously enrolled in MA for 12 months nearly doubled between 2000 and 2008. Despite the tremendous increase in the number of eligible individuals, MA-certified dentists were critical in increasing the utilization rate (at least one dental visit in the 12-month period) for these continuously-enrolled individuals from 31 percent in 2000 to 33.6 percent in 2008.

• That same report indicates some 43 percent of actively practicing Wisconsin dentists participates in the MA program, which is a higher percentage than other states. In 2007, the state Department of Health Services provided a fiscal estimate on the impact of providing fair-market rates for services to MA patients. In providing the global fiscal estimate, DHS stated utilization by MA patients could be expected to increase by 25 percent each year of the biennium for a net increase of 56 percent in the number of MA patients receiving dental care during the two year period under fair-market rates. A survey conducted by the WDA a few years ago also indicated 80 percent of dentists would begin seeing MA patients or increase the number of these patients being seen with fair-market reimbursement.

• HMOs are under contract with the state to provide dental services to MA patients in six counties: Milwaukee, Waukesha, Racine, Kenosha, Washington and Ozaukee. The WDA opposes contracting of dental services to HMOs after a 2008 Legislative Audit Bureau report showed these programs cost the state more money and provide less care than what is provided under the fee-for-service program operating in the other 66 counties.

• The state's most current dental MA data shows Wisconsin and federal governments spend just 1 percent, or just $76 million of a $6.6 billion annual MA budget, on oral health programs for children and adults. In comparison, 80 percent of other states spend a greater percentage of their MA budgets on delivering dental care to low-income patients. The American Academy of Pediatrics (physicians) has determined that 20 percent of all health care funds spent on children should be spent on improving and maintaining their oral health.

• Data from the state’s fee-for-service MA program shows that as of fiscal year 2010, the state spent $146.6 million in dental care services for the MA population and yet the state/federal government only paid $58 million (or 39 percent) of those charges, leading to dentists donating $88 million to the program as a result of their participation.

• The vast majority of dental care provided to MA patients is done in traditional small dental office settings. These stand-alone small businesses, unlike the medical model, are not connected to a nonprofit parent hospital or profitable medical arm where large losses can be shifted (read more about why dentists don’t cost-shift). Dentists who are MA providers not only donate their services, they pay out-of-pocket for dental staff and overhead costs that are not covered by government funding.

• Dental patients enrolled in state insurance programs CAN pay for their own care IF they see a dentist who is NOT a registered MA provider. Dentists who are not MA/BadgerCare certified can accept cash from patients enrolled in these state insurance programs. Approximately 50 – 60 percent of all dentists in Wisconsin are not MA/BC certified, so MA/BC patients do have the option of seeking care from these dentists and working with the office to make payment arrangements that are outside of the very limited MA/BC fee schedule set by the state.

• Dental hygienists can provide care to MA patients and receive reimbursement independent from a dentist. These changes went into effect in 2005 and since then very few hygienists that have become MA providers or choose to treat MA patients. Furthermore, MA patients have the greatest amount of dental disease making them most in need of the services that only a dentist can provide.