RESUMO
Purpose: This study assessed state Medicaid dentist enrollment processes and identified best practices for state authorities. Methods: A 2018 search of state government websites identified entities involved in enrolling and credentialing dentists. States were classified according to their administrative approach. Results: 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. Conclusions: 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.
