By. Dr. Steve Richardson
KDA Executive Director

Many of you are hopefully now aware that the KDA is making a concentrated push for significant changes within the Kentucky Dental Medicaid Program prior to and during the upcoming 2026 Legislative session. Being a ‘budget’ session, we are strongly focused on improving the funding levels of the program and ultimately the reimbursement levels provided. A full “carve-out,” or removal from the current MCO system is also being discussed, with many legislators viewing dental as a ‘test group’ for further Medicaid changes and improvements.

While the corrective needs go far beyond reimbursement alone, it is impossible to ignore the obvious statements that our providers are being asked to work at a loss to treat this population. The continued small business nature of dentistry in Kentucky only amplifies this issue. Most offices are not members of large groups or under umbrella organizations to help protect them financially. Without addressing the obvious shortcomings, this program is destined to collapse, as more offices are forced to decide to reduce involvement, or that they can no longer participate.

Why should this matter to you if you are not a Medicaid provider? Because Medicaid affects your office daily in this state. Insurers use the prevailing Medicaid rates in their actuarial establishment of their reimbursement levels. Our ridiculously low reimbursements within the Medicaid program are holding down insurance reimbursements. This is why, if you practice in an area near a state line, you are painfully aware providers across that line in any direction are being reimbursed at a rate significantly higher than you.

As far as we are aware, every private insurance available in Kentucky is an HMO or PPO plan, meaning you set neither your fee nor the amount you collect. It is dictated by the contract you have agreed to. If you choose to raise your fees, you only write off the difference.

Raising the funding and the reimbursement within the Medicaid plan will immediately provide relief for those choosing to participate and may allow program expansion by seeing those providers be willing to see more patients or others join the program anew. If we cannot bring about these changes, you may well see big changes to the look of dentistry in Kentucky forced on us in an attempt to address the access issue. This could include anything from provider taxes, forced enrollment and patient assignments, and dental therapy or mid-level providers. At the recent meeting in Frankfort to start on the Kentucky Oral Health Strategic Plan for 2031, it was announced well over 90 of our 120 counties have been certified as ‘Dental Shortage’ areas. We must improve reimbursement to make it more feasible for new dentists and practices to move into our rural communities. The population is there; but we need the economics to help it work. Our new graduates are leaving school $300,000-plus in debt. We need to make them feel comfortable deciding to stay in this state.

We are making a concentrated effort to encourage dentists to reach out to their state legislators for discussions or a visit to your office. Introduce them to the folks you employ, talk about the patients within their communities you provide care for, discuss the challenges you address daily and tell why you do, or do not, participate in Medicaid. Be honest, because very few of our legislators have any background in healthcare. These discussions are no different than discussing treatment with a patient. Keep it simple, share the facts.

On that note, we have available at the KDA office numerous toolkits and packets on talking points, how to contact your legislator, and handouts to leave with them when you meet. Reach out to the KDA office and we will get them to you. Hopefully you were able to participate in one of our online training sessions. If not, we will be recording them and posting them on the KDA website.

Our lofty goal is to have every legislator contacted by a dentist within their home district before the holiday season. Our goal is November 15. By meeting with them, you can share the necessary information and establish yourself as their local contact. Then when you receive the notices to reach out during the session at pertinent moments, your message will carry even more weight.

We can do this! I know there is a lot of negativity surrounding Medicaid and Federal funding, but we truly have an opportunity to make this happen now. We have been working toward this moment for several years, and the time really is now! When you talk with your legislator, you will find they are very aware of the situation with dentistry in Kentucky. This is a discussion point in Frankfort. Our time is now!

Together we thrive! It’s time to make a difference, it’s time to take a stand, it’s time to work together to get this done!

Are you ready to step UP?!