Barriers and Facilitators of Medicaid Participation Among Dentists.

Importance: Dentists' limited participation in Medicaid is a substantial barrier to addressing the persistent unmet need for dental care among adult Medicaid beneficiaries. Objective: To assess dentists' experiences and perceptions regarding Medicaid and to identify barriers and facilitators to participation as well as strategies to improve dentists' participation and service delivery. Design, Setting, and Participants: This qualitative study involved semistructured individual interviews of dentists from 8 states (Maryland, Massachusetts, Michigan, New York, North Carolina, South Dakota, Wisconsin, Wyoming) about their experiences with and perceptions of Medicaid. The study was conducted between August 2022 and July 2023. Data were analyzed from September 2023 to September 2024. Main Outcomes and Measures: Themes related to Medicaid participation were identified through thematic analysis, and descriptive statistics were used to characterize the sample. Results: Of the 67 dentists interviewed, 46 (68.6%) accepted Medicaid, and 21 (31.3%) did not accept Medicaid. The sample consisted of 36 females (53.7%) and 31 males (46.3%), with a mean (SD) age of 45.1 (14.4) years and a mean (SD) of 16.4 (13.8) years of work experience. Three key domains affecting dentists' participation in Medicaid were identified: system-level, dentist-level, and patient-level factors. At the system-level domain, barriers to Medicaid acceptance, including low reimbursement rates, administrative burdens, restrictive benefit designs, and poor communication about benefits, played a role in perceived inefficiencies and limited dentists' engagement. Challenges at the dentist-level domain included language barriers, capacity constraints, stigma surrounding Medicaid, and concerns about financial sustainability. Factors at the patient level, including appointment adherence, unfavorable perceptions of preventive care, logistical barriers, and limited oral health literacy, had a potential role in limiting effective care delivery. Dentists who accepted Medicaid reported frustration with administrative inefficiencies and reimbursement rates, whereas those who did not participate in Medicaid emphasized financial stability concerns. Conclusions and Relevance: This study highlights the complex interplay of barriers and facilitators at system, dentist, and patient levels that impact oral health care delivery to adult Medicaid beneficiaries. Increasing reimbursement rates is important but should be complemented by efforts to streamline administrative processes, improve patient engagement, and support dentists through targeted incentive programs.