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Deciding Whether to Do This at All, lesson 3 of 3
Adults and Children Are Two Different Businesses
Children's dental care under Medicaid is required by federal law. Adult dental care is a choice each state makes, and states have changed their minds in both directions. So a practice built on children is standing on something far more stable than one built on adults, and the two need planning separately.
- Children. Federally required, broad, and steady year to year
- Adults. A state option, from comprehensive to almost nothing
- The risk. Adult benefits have been cut and restored before
- The plan. Know which half of your schedule sits on which footing
Why Children Are the Stable Half
Federal law tells every state Medicaid program to cover a broad set of services for children. Dental is one of them. That is why children's coverage looks much the same from state to state. It is also why it does not vanish in a hard budget year.
For a practice, that stability is the single most useful thing about treating children in the program. The benefit you plan around this year is very likely to be there next year.
It also means the obligation runs wide. Screening, diagnosis and the treatment that follows are meant to be covered when a child needs them, which is a different posture from an adult benefit built around a fixed list.
Why Adults Are the Volatile Half
Adult dental coverage under Medicaid is optional for states. Some cover a comprehensive set of services. Some cover emergencies and extractions and very little else. Some have sat at both ends within the same decade.
Treat that as a business fact rather than a political one. A treatment mix that works under a broad adult benefit can stop working when the benefit narrows. The practices that struggle are the ones that never split the two halves in their own numbers.
California has cut adult coverage and brought it back again. That is the reason to get the current scope from the program itself. Memory is out of date here, and so are most articles.
What to Do With That
Track your production and your schedule split by adult and child rather than as one number. If the adult benefit narrows, you want to already know what share of your chair time it was holding.
When you plan capacity, plan the child side as the base and the adult side as the part that can move. That is not pessimism, it is the same reasoning behind not signing a lease against your best month.
Check the current scope with your state program before building a service line around a specific procedure. What is covered for an adult is the question most likely to have changed since anyone last looked.
Before You Spend a Dime
Does the children's requirement mean everything is covered?
It means the program has to cover a wide range of services a child needs. Your state sets the detail within that. Get the current scope from the program rather than assuming the best or the worst.
At what age does a patient move from one to the other?
Your state program sets that line. It matters for planning, so confirm it. Do not carry a number over from another state.
Should a new practice start with children?
Many do, because the benefit is steadier and the demand is consistent. It is a reasonable starting point rather than a rule.
Next Problem to Solve
- Enrolling as a Medi-Cal Dental ProviderNext in the course. What enrolling in Medi-Cal dental involves, what slows applications down, and what to sort out before you start.
- Should Your Practice Take Medi-Cal PatientsRelated. A plain look at the economics of Medicaid dental for a private practice, and how some offices make it work.
- When the Right Treatment Is Not the Covered TreatmentRelated. What to do on the day the plan a patient needs and the plan the program will pay for are not the same, without either misleading the patient or quietly lowering your standard.
- The Numbers That Mean Something at These RatesRelated. Which practice metrics still work when the fee schedule is set by somebody else, which ones actively mislead, and the short list worth watching weekly.