The American Dental Association (ADA) has released a new report, Analysis and Recommendations for Medicaid Network Adequacy Standards and Enforcement, and a new guide, Medicaid Financial Sustainability Toolkit: An Operational Guide for Dentists Wishing to Treat Medicaid Beneficiaries. The documents offer analysis and insight for practices and policymakers alike. Policymakers and advocates can utilize these resources to improve access to dental care for Georgians, reversing a decade-long trend of declining dentist participation in Georgia’s Medicaid program.

Reporting on Georgia’s Network Adequacy

Network adequacy standards aim to establish minimum criteria, both quantitative and qualitative, designed to ensure beneficiaries access to care. Federal and state rules outline general expectations for network adequacy, but strategies used to pursue and monitor network adequacy vary depending on the state. Federal rules and approaches have varied with each new administration since 2015: The first standard set out by the Obama administration established rules designed to align requirements governing Medicaid managed care with similar requirements already in place for qualified health plans and Medicare advantage plans. The first Trump administration and the Biden administration would go on to propose revisions based on different regulatory approaches.

Target metrics currently used by the states share many commonalities. The most frequently used metrics are time and distance standards. Only 12 states lack this metric. Other criteria states use include minimum provider-to-patient ratios, minimum appointment wait times, consumer experience surveys, and standards for access to specialists.

ADA’s report ranks states on a 3-part scale, identifying them as standards not met, needs improvement, and innovating. Georgia is highlighted as a state that “needs improvement.” While it is featured in one section of the report for a requirement that Care Management Organizations (CMO) offer corrective action plans in the event that access falls below 90% in any county, Georgia is not considered to be part of the “innovating” group.

The report provides several policy recommendations.

1. Ensure any willing provider can participate in Medicaid with reasonable contract terms. Allowed contractual terms should not be prohibitive (underwater reimbursement rates, excessive audits, and major administrative challenges).
2. Encourage rural dental residency and incentive focused programs. Practicing dentists may be encouraged to work in rural settings through educational and other incentives, like federal programs that offer quarterly bonuses to providers in health professional shortage areas.
3. Enforce rewards and penalties to address CMO compliance or noncompliance.
4. Promote transparency and sufficient access to care. Publication of annual reports of provider participation and reimbursement, guidance for dental rate setting, and other solutions would bring much needed clarity to discussions about state policy.

How Many Dentists Actively Treat Medicaid Patients in Georgia?

In 2021, ADA’s Health Policy Institute published a brief indicating that 75% of Georgia dentists do not treat Medicaid patients and are not enrolled as a provider. Active provider directories from 2024 and data from the Board of Healthcare Workforce suggest that this trend broadly continues with a slight decrease, no more than half a percentage point, in provider enrollment. Of the 25% that were enrolled at the time of ADA’s brief, just under a quarter of those did not see any Medicaid patients.

Billing data from Georgia’s Department of Community Health suggests a decline in providers actively treating Medicaid patients. Counts by National Provider Identifier of dentists billing any amount to Medicaid declined between 2015 and 2025 with about 200 dentists choosing to stop billing altogether. Counts using Rendering Provider ID, a separate 9-digit identifier that includes a location specific letter, show a similar drop indicating a decrease in provider participation. The decrease in Rendering Provider ID count also suggests the possibility of a contraction in geographic availability of dental care.

Medicaid Financial Sustainability

The primary reason providers cite for choosing not to participate in treating Medicaid patients is cost. Georgia’s published fee-for-service reimbursement rates are around 40% of average dentist charges. As rates decline below 60% of average charges, practices begin to see the cost of treating the patient exceed the cost of providing services. The result is that dentists choosing to treat Medicaid patients are highly incentivized to minimize financial losses by controlling costs and increasing efficiency.

ADA’s new toolkit offers strategies and solutions to help providers meet these challenges. Many of these strategies are built around cycles of data collection and evaluation that are designed to help dentists see the big picture, and they are strategies that can help any practice run more efficiently regardless of payor mix.

Tips From Toolkit:

• Design schedules around predictable administrative steps. Focusing on systems for efficient scheduling and rescheduling allows high functioning practices to maximize total chair-time. This can be done through the use of scheduling templates built around predictable administrative needs such as eligibility verification, benefit verification, and prior authorization.
• Conduct regular reviews of key metrics. To set adequate policies conducive to long-term success, be aware of no-show rates, conduct regular morning huddles, closely monitor patient payor mix, and utilize preventative care rates to build optimal schedules around initial visits and risk-based recall.
• Optimize workflows. Develop a clean claims workflow. Tracking claims at every stage and standardizing documentation promotes appropriate record retention and smooths reimbursement. Coordinating the dental team to ensure everyone is working as a cohesive unit is a must.
• Utilize Technology to Overcome Barriers. Where possible, teledentistry, automated messaging systems with layered messaging, and other tools may be used to reduce no-show rates or bring dental care directly to the patient without the need for a visit to the office.
• Train Staff. Well-trained staff with clear responsibilities make all the above happen.

The toolkit reminds its reader that it is not state specific, and suggested strategies are dependent on state policies. The October 2025 edition of Georgia’s Medicaid policy manual related to dental care can be reviewed using the button below, and others can be found in the state’s GAMMIS portal.

Dental Services Q4 October 2025

Future Advocacy

To be a part of the conversation in Georgia, join GDA’s advocacy efforts. Every year, GDA’s contact dentists help local legislators understand how policies being considered under the gold dome impact dentistry. Advocacy happens at the Capitol, and it happens right in every dentist’s back yard. Don’t forget to sign up for LAW Day 2026 and attend the 2025 legislative reception in a district near you.