Oregon pediatric dentists say cuts by a Medicaid benefits manager are squeezing already thin margins and threatening access to care for the state’s neediest children.
Dr. Tesha Waggoner, owner of Pine Tree Pediatric Dentistry in southwest Portland, accepts a large share of Oregon Health Plan (OHP) patients — including children in foster care and those with severe intellectual, developmental and physical disabilities.
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She says recent rate reductions from a company that manages benefits for many of her patients will slash roughly 60% from the fees she receives for about 40% of her caseload.
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Waggoner estimates the reductions will cost her practice about $46,000 over two months. She is weighing cuts to staff hours or a restructuring of the practice to keep serving OHP patients sustainably.
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The Oregon Health Authority (OHA) has repeatedly identified low Medicaid reimbursement as a major reason many dentists avoid OHP.
A state analysis found Oregon pays dental providers just 28.3% of what other payors do — far below neighboring Washington (42.9%) and California (44.9%). Dentists also report that Medicaid requires more paperwork than private insurers.
That combination has left much of the state underserved. Researchers from OHA and Oregon Health & Science University found 32 of Oregon’s 36 counties lack enough dentists who accept OHP to meet demand. A 2019 American Dental Association survey showed 58.8% of Oregon dentists were not enrolled to take Medicaid.
OHA declined an interview but issued a statement noting that states are only required by federal law to cover dental services for children through age 20, and that Oregon expanded adult dental benefits after Medicaid expansion under the Affordable Care Act.
The agency also said it increased payment rates in recent years for children and young adults with special health care needs by about 50% on average.
Still, families say access remains difficult. Hayley Palmer of Tualatin has struggled for years to find dentists who will treat her 9-year-old daughter, Mila, who has severe cerebral palsy and relies on a feeding tube.
Mila recently received multiple procedures under sedation at Doernbecher Children’s Hospital, including cleanings and the removal of baby teeth.
“Cleanings are important because mouth bacteria can cause pneumonia, which can be deadly for a child like mine,” Palmer said. She added that basic dental care also helps her daughter’s appearance and dignity.
Finding providers who both accept OHP and treat children with complex needs is especially hard, Palmer said. She called every dentist on a hospital list and found many no longer accepted OHP or children with specialized needs.
Pediatric dentists say low reimbursement forces them to limit how many Medicaid patients they see. Dr. Hai Pham, who treats children in Portland-area hospitals and runs clinics in Washington County, said his practices balance OHP patients with privately insured and self-pay patients. “If everything I did was Medicaid, I’d be in the red,” he said.
Pham, who also serves in the Oregon Legislature, and Rep. Cyrus Javadi introduced a bill this year that would have required Medicaid and its benefits managers to pay roughly 60% of the average commercial rate for dental services. The bill died in committee without a cost estimate. Javadi said raising rates would likely force the state to cut spending elsewhere.
Both dentists point to administrative burdens as another deterrent. Pham described differing reporting requirements across benefits managers.
Javadi, who runs a practice in Tillamook, said rural dentists also face recruitment and retention challenges, making it harder to serve OHP members outside metro areas.
Missed appointments compound financial strain. Patients facing poverty often lack reliable transportation or face other barriers that increase no-show rates, which further discourages providers from taking OHP.
Despite these pressures, some dentists stress a professional duty to serve vulnerable children. “That is a patient population that I will always see,” Waggoner said. “That’s who I believe we’re obligated to see as pediatric dentists.”
Until state policymakers address reimbursement and administrative hurdles, experts say access for OHP enrollees is likely to remain uneven across Oregon.