I’m utterly amazed at how few orthodontists accept Medicaid. If you don’t want to treat this very large group of potential patients that is certainly your right and I wouldn’t care what you do except for the fact that you:

  • You constantly complain about not having enough new patients
  • You make wild generalizations about a group you don’t know and won’t serve and I don’t like seeing wanton prejudice besmirch our profession

I am an access to care guy. Period. I will always put increased access to care above all else and my track record speaks for itself. As strange as it may sound, most orthodontists think that increased access to care is at odds with their self-interests. I had a conversation just the other day with an orthodontist who stated this unequivocally in a group and was widely agreed with by fellow orthodontist. This is a terrible place to be and is contrary to our duty to the public. It is also evidence of a scarcity mindset. Thinking in terms of scarcity instead of abundance is a terrible place to be. Read the book, Secrets of the Millionaire Mind if you don’t know what I’m talking about and want to improve your paradigm massively. The vast majority of orthodontists don’t accept Medicaid or limit the number of Medicaid patients they see because they worry about what they won’t get. But they totally ignore the benefits of warmly accepting Medicaid patients into their offices. Let’s ignore the moral imperative that I believe exists for now and discuss the business argument for accepting Medicaid patients. To begin with, let’s look at the reasons I’m often given as to why accepting Medicaid is bad:

  • The state doesn’t pay enough.
  • There is too much paperwork.
  • Few of the patients on Medicaid score enough to qualify for treatment.
  • Only the hardest cases score and I’m not paid much for doing the hardest cases.
  • Those people” will run off my “normal patients” because “normal people” don’t want to be around “those people”.
  • Those people don’t show up on time.
  • Those people don’t brush.
  • Those people are always breaking stuff.
  • Those people always bring in a bunch of friends and family members to their appointment and fill up the waiting room.

SERIOUSLY???? In this day and age? Do you know what would happen if you spoke like this in public instead of to a bunch of orthodontists who nod in ignorant agreement? As a thought exercise let’s substitute European, Asian, African, Jewish, Muslim, Christian, Hispanic, White, Black, female or male for “those people” in any of the all too typical conversations about “those people” held among orthodontists. How would that go over? Why is labeling and decrying ANY group acceptable then? How can you judge everyone who is on some form of government assistance based on what your professors told you? How can you judge individuals based on traits you’ve blindly assigned to their group? You readily admit that you don’t accept Medicaid patients so how do you know what you’re talking about? Even if you have some experience with some Medicaid patients, that doesn’t give you the right to paint all the individuals who have Medicaid with one brush. You know better than that! Finally, in my experience, Medicaid only covers kids so how can you blame and exclude kids from your practice based on their parents’ socio-economic status? Don’t you want all kids to have access to care and a great smile? Do yourself and your peers a favor and stomp this kind of behavior and conversation down whenever you hear it. Let’s take each of these objections in turn and discuss them logically rather than emotionally:

  • The state doesn’t pay enough – This sounds logical enough. You have overhead and if the amount the state offers to pay is not enough to “cover your overhead” then it doesn’t make sense to accept Medicaid, right? WRONG. Unless you are at capacity, adding a few patients a month at a greatly discounted fee doesn’t cost you money, it makes you money. Think about it. You have open chairs and idle staff. The only cost to you for adding these patients is the cost of brackets and wires and the like. Plus you said yourself, Medicaid patients never qualify anyway so what are you worried about?
  • There is too much paperwork – Seriously? This is the weakest of all the reasons not to do Medicaid. There is no more paperwork to be done for Medicaid than there is for the average insurance company.
  • Few of the patients on Medicaid score enough to qualify for treatment – This is by design. Medicaid should only pay to treat the worst cases. I know there are exceptions and no system is perfect but that’s the goal. Look at it this way, you’re so worried about not getting paid enough by Medicaid so the fact that few score enough for reduced fee treatment is a win for you!
  • Only the hardest cases score and I’m not paid much for doing the hardest cases – Whaaaaaa! Get over it. You’re a specialist, these kids need help and you are doing a public service – plus you just said that very few qualify so you won’t have many to cry about.
  • Those people” will run off my “normal patients” because normal people don’t want to be around “those people” – This is far and away the most offensive and dumbest of the reasons not to take Medicaid. Orthodontists create an issue where there is not one. It’s like they want to bring back segregation and create a two-tiered healthcare system. Do you think hospitals, department stores, restaurants or any other business think in this way? Again, substitute any other group name for “those people” and you will see just how reprehensible this argument is. Just because your peers agree with you doesn’t make it right – it makes you all wrong.
  • Those people don’t show up on time, don’t brush and are always breaking stuff – The problem with this argument is threefold.
    1. Those people don’t commit these offenses any more than “normal patients” do in my vast experience. We hold everyone to the same standard and find that most comply and a few don’t no matter what we do. You will find the same if you treat everyone equally and have a great attitude.
    2. You don’t have any experience because you admittedly don’t take Medicaid, so you are speaking with authority about something you have heard but don’t know.
    3. Finally, if you do have experience with “those people” in some corporate setting, you mustn’t underestimate the power of systems and expectations on the orthodontic office’s side of the equation to cause and perpetuate behaviors. Read Leadership and Self Deception to learn how we need to see the behavior we expect (and despise) to justify our prejudices. If “those people” call the office and are treated like dirt then do you think it might impact how often they show up? If they are forced to go to that office because it’s the only place that accepts Medicaid, do you think being treated like a subhuman by the doctor and the team might impact compliance? I do.
  • Those people always bring in a bunch of friends and family members to their appointment and fill up the waiting room – What the what? You mean you don’t like patients who bring other potential patients with them to their appointment at your office? Are you insane?

Now let’s talk about the reasons you should accept Medicaid patients – as many as are willing to show up!

  • It’s not about the patients who score enough to get a scholarship from the state; it’s about the ones who don’t – Patients in the door is or should be an orthodontist’s primary motivation when it comes to her business. If something brings more patients in the door then it is worth the effort. If not, it’s ancillary. To that end I will argue that accepting Medicaid is one of the if not THE best way to get more patients in the door. A magical thing happens when a Medicaid patient doesn’t score enough to get a scholarship from the state (yes I call it a scholarship to make the kids who receive assistance feel good about themselves). In that instant a Medicaid patient doesn’t score, they become a private pay patient, many of whom have private insurance! If you play your cards right, have a great attitude, offer reasonable financing and make “those people” feel at home, more than half of those who do not qualify for a scholarship will pay you for braces!! Enough said.
  • Accepting Medicaid is better than being a provider for an insurance company – You only have to give a discount to those rare few who score enough for Medicaid but you must discount all the patients with an insurance you are a provider for. Tell me how I’m wrong about this? You get all the benefits of being listed on the Medicaid website and you get people in the door but you don’t have to give a discount across the board. Count the discounted fee you give the few Medicaid patients who qualify as a marketing expense if it makes you feel better, but focus on what you get instead of what you don’t get.
  • Medicaid patients have siblings, stepsiblings, friends, classmates, neighbors and people they know who are not on Medicaid but still need braces. I know it is different where you are but do you have divorce there? If you do then you will have families that include some kids on Medicaid and some that are not as a result of divorced people getting remarried. If you don’t take Medicaid you will not get access to any of these potential patients. To put it simply, you are missing out on a huge stream of non-Medicaid new patients if you don’t accept Medicaid!
  • It doesn’t matter how much Medicaid reimburses you for a case – I say it all the time, if Medicaid paid $1 per case it approved I would still accept Medicaid. Missouri doesn’t pay much more than that and we are still one of only a handful of providers! Again, it’s not about the patients who score enough for state assistance, it’s about those who do not and all their family and friends.

Now for a couple caveats if you decide to start taking Medicaid:

  • You will have to change your mindset and get out of your box. Again, Leadership and Self Deception is a great book to help you do this. Changing yourself is the easy part. You will also have to change the way your staff thinks about and acts towards “those people”. This is hard and may require that you fire a few employees who are unwilling to see everyone as equally deserving of access to care, but getting your culture right is crucial to being successful with this clientele. It’s kinda ironic that I’ve been railing against you generalizing when it comes to Medicaid patients because generalizing is what I’m going to do right now. I can tell you from experience that the very best way to maximize the number of new patients you get from accepting Medicaid is to be nice and be grateful that patients show up at your office. All patients. Medicaid patients are used to being treated like second class citizens and will react very positively if you treat “those people” with the kindness and respect you treat everyone else. It shouldn’t be hard to do but for some reason many orthodontists and their teams struggle with their humanity in this area. I can tell you that if you get the reputation for acting kindly and humanely towards Medicaid patients, you will receive a huge influx of Medicaid patients and their friends and family and neighbors – some of whom are on government assistance and some of whom who are not, as we have discussed. If you cannot get your culture right or are unwilling to wage the necessary culture war in your office then I would advise that you don’t change your stance on Medicaid because you will find exactly what you expect to find.
  • You have to understand that people are people and that a certain percentage of people are jerks who don’t hold up their end of the bargain. This goes for Medicaid patients just like everyone else but if you focus on what goes wrong, your staff will too and you will get terrible results. I can tell you from vast experience that I find Medicaid patients generally more compliant than the children of the affluent and way more compliant than dentists’ kids!

Accepting Medicaid is good for your practice and good for your community. Kids are kids, people are people and all of them deserve a shot at a great smile and a happy life. It’s good to do good while doing good is something I was taught early in my career and this mantra has served me well. I just wish someone had told me what I’m telling you as to why I should have accepted Medicaid when I first started practicing. I eventually figured it out for myself but it wasn’t until after I built a second office in Jonesboro, AR to accommodate “those people” and keep them from running off my “regular patients”. What a jackass I was!

Don’t be like jackass me. Get rid of your bad attitude and switch to accepting Medicaid today!

2 thoughts on “Why I Accept Medicaid & You Should Too

  1. Amen!!! I couldn’t possibly agree more. We currently accept care source which in Ohio is funded through Medicare. Do you think Melena and Medicare are worth it as well.

    How long have you been with Orthosynetics? I’m baffled that they didn’t think this was a good idea for one of my struggling offices

  2. That is strange Chuck. I’ve been an OSI client for going on 4 years now. They have been instrumental in helping me expand my patient base and free myself from being dependent on traditional referral sources.

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