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Apple Health dental reimbursement rates increase – State of Reform


Reimbursement rates for almost all services covered by Apple Health increased by 100% on July 1. 

During the 2021 legislative session, Washington state lawmakers set aside $76 million in its 2021-23 budget to improve access to care through increased fee-for-service reimbursement rates for serving adult dental Medicaid patients.. 

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Washington state’s Medicaid dental rates have been among the lowest in the country, according to the Arcora Foundation, Delta Dental of Washington foundation. This makes it difficult for providers to participate in the program. Reimbursement rates haven’t increased in Washington state since 2007. Before the increase, Medicaid reimbursement rates were about 32% of the total cost of providing service, compared to a national average of about 50%. 

Arcora writes that:

“The result is that Apple Health dental coverage, while essential, does not always equate to access to care. These new increased reimbursement rates for Apple Health adult dental services show real progress in our state’s commitment to improving oral health equity.” 

Vanetta Abdellatif, President & CEO of Arcora Foundation said the following:

“Lower-income Washingtonians and Black, Indigenous and People of Color populations face far too many barriers to accessing needed dental care, exacerbating health disparities. The increased investment in the Medicaid adult dental program is an important step toward building a stronger program that can move our state closer to achieving oral health equity.”

Dentists who already accept Apple Health insurance automatically already began receiving increased reimbursements starting last month. Apple Health covers a number of dental procedures ranging from routine exams and once-a-year cleanings, to tooth extractions and fillings, among others. 

Arcora Foundation partnered with Washington State Dental Association the to encourage dentists to enroll as Apple Health providers. Across the state, 29% of people are covered by Apple Health, but fewer than four out of 10 have been to a dentist in the last year, according to the Arcora Foundation. 

Alison Mondi, policy director for the Arcora Foundation, said other ways to help dentists come into the Apple Health network is by offering resources, education on the Medicaid system, and assistance with billing. 

“I think as we look forward, we want to build on those investments and build a more sustainable program,” she said. 

Dentists who enroll as Apple Health providers can also sign up for DentistLink, Arcora’s free referral service that directs patients to care. Dentists who do accept Apple Health can decide how many adult Apple Health patients they see at their practice. 

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