U.S. court rules dental therapists can receive Medicaid payments

2021 05 14 16 00 7776 Scales Of Justice2 400

The U.S. Court of Appeals for the Ninth Circuit recently ruled that dental health aide therapists in tribal communities in Washington can receive reimbursements from Medicaid, reversing a last-minute decision by the Trump administration.

The court ruled in favor of the appeal that was filed by the Washington State Health Care Authority and the Swinomish Indian Tribal Community, ordering the U.S. Centers for Medicare and Medicaid Services (CMS) to approve Medicaid funding for dental therapists, according to a court opinion filed on January 12.

In March 2021, after President Joe Biden took office, the state and the Swinomish community filed the appeal after the CMS denied Washington's request to amend Apple Health, the state's Medicaid plan, to include dental health aide therapists on the list of licensed providers who can be reimbursed through Medicaid, the opinion states.

On the last day of the Trump administration and nearly a year after an independent U.S. hearings officer recommended that funding be approved for dental therapists, the CMS rejected the amended state plan on the grounds that it violated the Medicaid free choice of providers provision guaranteeing all Medicaid beneficiaries equal access to qualified healthcare professionals willing to treat them. Under the George W. Bush administration, the CMS had approved Medicaid funding for a similar dental therapist program in Alaska.

"CMS's rejection of the amended state plan was not in accordance with law," according to the court opinion.

Once CMS approves the Medicaid funding for dental therapists in Washington, the U.S. government will cover the costs of these services for Medicaid patients in the state. Currently, the state is paying for these services.

Currently, 13 states, including Colorado, Michigan, and Idaho, authorize dental therapists to practice in some settings. In Washington, dental therapists are restricted to practicing in the tribal healthcare system.

However, members of the Swinomish tribe continue to advocate for dental therapists to be authorized throughout Washington. In December 2022, tribe members testified before Washington state lawmakers that passing legislation authorizing dental therapy statewide would expand access to oral healthcare.

The Washington State Dental Association opposes the use of dental therapists statewide but recognizes the "sovereignty of tribal governments" to use them, according to a article published on December 26 in the Skagit Valley Herald.

Bracken Killpack, the association's executive director, called the severe shortage of dental hygienists in the U.S. the most significant workforce-related barrier in Washington. However, rather than allowing for further authorization of dental therapists, Killpack is advocating for the expansion of college dental hygiene programs, according to the article.

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