Texas Medicaid Dental Managed Care

A Proven, Cost Effective Delivery Model

After several years of explosive costs in the dental Medicaid program in Texas—due primarily to dramatic overutilization of orthodontia services—the Legislature and HHSC sought to address the cost crisis by initiating a shift from the traditional fee-for-service model (FFS) to the managed care model to better manage costs and increase access to and quality of care. Since this shift began in 2012, the use of dental managed care for Texas Medicaid dental services has significantly reduced costs for taxpayers while improving access to timely, quality, preventive care for Texas children enrolled in Medicaid.

Dental Medicaid Managed Care Resources:

Medicaid Dental Managed Care: Delivering Success and Savings in Texas

A resource guide on how dental Medicaid managed care operates in Texas

September 2015

Dental managed care is an alternative to the traditional Medicaid fee-for-service (FFS) model. Under FFS the state contracts directly with dental providers and reimburses them for each service delivered. The FFS model pays based on the volume of services provided, which can encourage overutilization of unnecessary and expensive services. Under dental managed care, the state pays a fixed fee per-person, per-month (known as capitation or a premium) to a dental managed care organization (DMO). The DMO assumes the full financial risk of costs, limiting the state’s financial exposure.

Texas Medicaid Dental Managed Care Delivering Results: Savings Access, and Oversight

A factsheet highlighting the success and outcomes of dental managed care in Texas.

September 2015

The transition from the traditional fee-for-service (FFS) model to dental managed care has resulted in lower costs with an increase in access and quality of care. The use of managed care for Medicaid dental services has also improved access to timely, preventive care for children.

Understanding Texas Medicaid Dental Managed Care

PowerPoint presentation on the outcomes and operations of the Texas dental Medicaid managed care program.

September 2015

In 2012 Medicaid Dental Managed Care replaced the costly fee-for-service approach in Texas. As a result, by 2014 nearly 3 million children and young adults were receiving dental services, and now 90% are enrolled in dental managed care.