Medicaid Dental Provider Enrollment Processes: National Assessment and Policy Recommendations

This study assessed state Medicaid dentist enrollment processes and identified best practices for state authorities. A 2018 search of state government websites identified entities involved in enrolling and credentialing dentists. States were classified according to their administrative approach. Twenty-two states administered their dental programs internally, 24 through contracted Medicaid managed care organizations (MMCOs), and five through a combined approach. Thirteen of 22 (59 percent) internally-administered and eight of 24 (33 percent) MMCO-administered states carved out their dental programs to a dental managed care organization. Twenty-one of 22 (95 percent) state-administered but only nine of 24 (38 percent) MMCO-administered programs provided complete enrollment instructions. To serve the entire pediatric Medicaid population in a given state, dentists needed to enroll and be credentialed by one to eight entities. Providers needed to complete an average of one application and one contract in carved-out and internally administered states, three applications and two contracts in dental MCO carved-out states, and five applications and four contracts in MMCO states. Medicaid enrollment complexity varies considerably across states and is highly influenced by managed care. Recommendations to enhance the enrollment process include dentist-specific guidance, online and automated enrollment platforms, streamlined applications, and application consolidation.