Dental Collections and the Big Beautiful Bill

This year, Congress passed into law the President's "Big Beautiful Bill." As part of that bill, many estimate more than $1 trillion in funding cuts in Medicaid over the next decade. For dentists who accept Medicaid patients, the new rules on eligibility also make it more difficult to get reimbursed. Two of the new rules that might directly affect dentists' ability to get timely reimbursed are:

1. Work requirements for able-bodied adults without dependents, to be enforced by January 1, 2027.

2. Imposed 80-hour-per-month work requirement on many adults receiving Medicaid, and applying existing SNAP work rules to additional beneficiaries.

Expect stricter Medicaid eligibility enforcement from federal and state goverment agencies. What this could mean for dental practices is:

• With eligibility requirements tightening, more patients may experience lapses in Medicaid coverage. This increases the risk of claim denials and payment delays.

• Front desk staff may get burdened by more administrative tasks to verify patient coverage. Staff may need to check multiple databases the verify that the patient has or had coverage at the time the practice served the patient. In the worst case, staff will need to verify the patient's current work status, hours worked, and coverage limitations to date.

• Dental practice workflow could get complicated. Should the front desk start the verification process sooner than usual? Will verifications from multiple sources delay the patient's treatment? Should it? What happens if the patient loses eligibility after the front staff completed its research? Is there be a safe haven provision?

• Dental practices may lose clients. If the front staff cannot timely and accurately verify eligibility and a patient's obligation, patients may forgo that treatment and future ones.

The states are expected to resolve most of these issues in the next several years. In the meantime, dental practices may need to do extra work to ensure they are timely paid by Medicaid.