PeachCare is the Georgia version of SCHIP . . . the State Children’s Health Insurance Plan. PeachCare is funded through taxpayer dollars, with roughly a third coming from federal taxes.
In addition to medical care, the PeachCare plan cover’s dental benefits for qualified children up to age 18. In addition to funding issues, Peachare (and any other taxpayer funded health care plans) face major hurdles for accessability.
Many providers are refusing to service PeachCare/Medicaid patients due to the low reimbursement rates. In 1999 roughly 260 dentists accepted PeachCare/Medicaid as a form of payment. The state agreed to increase reimbursement rates which led to an increase to 1800 dental providers over the next few years.
That number is now down to less than 600 participating dental providers.
Every time a PeachCare/Medicaid patient is treated, the dental provider loses money unless they are running some kind of scam. Georgia is not the only state with disappearing providers. Here is a letter to the editor from a dentist in California.
When I first started in Gilroy from scratch in the early ’80s, I found the Denti-Cal program very useful. It worked well and “saved my bacon” during those early days of getting my practice started.
Then things suddenly changed! About 1985 we suddenly found that whenever we submitted a Denti-Cal claim for more than $100, they found a reason to not pay.
So, without being able to do any substantial work and get paid, I had to reluctantly drop the program.
Zip forward to the late ’90s. I wanted to be a good citizen and do my duty for society’s unfortunate, so we tried Denti-Cal again. We found three major problems. First, the reimbursement level was 20 to 40 percent of our normal fees; and with a business overhead of well over 50 percent. This meant doing Denti-Cal at a financial loss. Second, we found it very difficult to get paid at all, even at those low rates due to massive bureaucratic red-tape. And third, we found that Denti-Cal patients were not responsible enough to keep their appointments, adding insult to injury! (Link to letter)
One of my clients recently stopped accepting PeachCare/Medicaid. He can no longer afford to provide the level of service his patients deserve based on the low reimbursement from this taxpayer funded program.
Federal funds are part of the Spendulus Bill are not the answer. No one is served when the idea is to expand eligibility without addressing the shortage of dentists willing to serve this population base.
Just another crazy government idea gone bad and a total waste of taxpayer dollars.