ADEA State Update

Reports of Interest - November 2017

(State Policy, Funding, Medicare and Medicaid Services, Dental Health) Permanent link   All Posts

DataAnalysisKeyThe Oral Health Workforce Research Center (OHWRC) at the Center for Health Workforce Studies (CHWS) at the University at Albany School of Public Health published a report analyzing the development of dental support organizations (DSOs) in the United States. Described below are some key findings in the August 2017 report:[1]

  • DSOs were mainly for-profit organizations (96.8%), and a majority were privately held (62.5%).   
  • DSOs were operating in 48 states and the District of Columbia. There was no DSO presence among respondent groups in Alaska and Montana.
  • Dentists were affiliated with DSOs in various ways, including as associates (66.7%), owners (66.7%) and employees (53.7%).
  • The mean number of full-time dentists affiliated with a DSO was 213; the number of full-time dentists in DSOs ranged from a minimum of six to a maximum of 1,500. The median number of full-time dentists was 60.
  • DSOs recruited some new dental school graduates annually, but many of the organizations mainly recruited experienced dentists. Sixty percent of survey respondents indicated that between 51% and 100% of new recruits annually were experienced dentists.
  • All DSOs (100.0%) provided similar business and management services. However, fewer than three-quarters (71.9%) had a common electronic dental record, and fewer than half (46.9%) provided clinical care protocols to affiliates.
  • DSOs varied in the number of patients served by practice affiliates in 2016. The range was 6,000 to 1.6 million patients.
  • The number of patients served by a DSO was not necessarily an indicator of the number of states in which that DSO operated. Some DSOs with large numbers of patients operated in only one state, while other DSOs with smaller numbers of patients operated in multiple states.


The National Association of State Budget Officers (NASBO) has released a report which indicates that most states enacted budgets with slow spending growth in FY18 in response to concerns of an uncertain economic outlook in the states, based in part on uncertainty at the federal level, considering Affordable Care Act (ACA) repeal and replace efforts, potential changes to Medicaid funding and the possibility of tax reform as well as contending with slow gains in state tax collections. In addition, states are yet again trying to address certain program areas, such as state spending on Medicaid, which is continuing to grow faster than the budget as a whole.

However, despite a challenging revenue environment, states still identified specific areas to receive increased funding or emphasis in FY18, including:

  • Initiatives to reduce Medicaid spending growth.
  • Initiatives to provide increased tuition assistance at two or four-year institutions.
  • Efforts to address the opioid epidemic.

The NASBO report details state-by-state, in alphabetical order, each state governor’s proposed budget for FY18 and what was actually enacted with regard to Medicaid program changes, higher education policy initiatives, and new policies to address the opioid epidemic.


The Henry J. Kaiser Family Foundation and the National Association of Medicaid Directors have released a report providing an in-depth examination of the changes taking place in Medicaid programs across the country during this time of uncertainty with regard to potential changes in federal policy and funding. 

Medicaid covers one in five Americans, accounts for one in six dollars spent on health care in the United States and more than half of all spending for long-term services and supports, and it is a state budget driver as well as the largest source of federal revenues to states. Medicaid is constantly evolving, as state and federal policymakers strive to improve program value and outcomes through delivery system reforms, respond to economic conditions or public health concerns (such as the opioid epidemic) and implement federal policy changes, including those in the ACA or other regulatory changes (like the recent Medicaid-managed care rule).

Key findings from the report show that despite uncertainty about federal legislative changes, many states were continuing efforts to expand managed care, move ahead with payment and delivery system reforms, increase provider payment rates and expand benefits as well as community-based long-term services and supports. Emerging trends include proposals to restrict eligibility (e.g., work requirements) and impose premiums through Section 1115 waivers, movement to include value-based purchasing requirements in managed-care organization contracts and efforts to combat the growing opioid epidemic. Key areas to watch for in 2018 and beyond include federal legislative efforts to restructure and limit federal Medicaid financing as well as Section 1115 waiver activity. 

[1] In the spring and early summer of 2017, the OHWRC conducted a short survey of a convenience sample of 47 DSOs in the US.

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