Texas Dentists, Medicaid Patients and Law: The Frew Order

Posted by AMY HUYNH | Jul 15, 2023

Federal law requires Texas state Medicaid agencies to prioritize basic healthcare for indigent children. In Texas, the Early, Periodic, Screening, Diagnosis, and Treatment (EPSDT) program is known as "Texas Health Steps." This article explores the Frew Order, a crucial legal development, and its implications for dental Medicaid access in the state. 

The Frew Order and Provider Shortages

Since 1993, Texas mothers have voiced concerns over a shortage of healthcare providers willing to accept Medicaid patients for their eligible children. This shortage primarily stemmed from the state's significantly low reimbursement rates for care. After a court battle and intense negotiations, the parties involved entered into a consent decree in 1996.

Filed documents demonstrate that the provider-to-patient ratio was 1 to 876, with most providers caring for less than 100 class members [Frew v. Janek, 820 F.3d 715, 725].

Any guess what the current ratio of dentists to children on Medicaid is today?

Incentivizing Texas Dentists to Accept Medicaid

The Frew Order required Texas to incentivize health care providers to accept Medicaid. One provision of the settlement required the state to increase reimbursement rates 100% on 35 of the most common dental procedures. Between 2000 and 2008, children receiving dental services increased a whopping 270%.

Violations and Corrective Action

Texas has violated this decree numerous times, in 2000 (109 F. Supp. 2d 579), in 2007 (when dental reimbursement rates doubled), again in 2011 (Case No. 3:93-cv-00065 Frew v. Suehs, 775 F. Supp. 2d 930), with the most recent Corrective Action Order being filed in 2020 (Frew v. Smith, Case No. 3:93-CV-65). 

The Frew Order served as a critical turning point in addressing healthcare provider shortages and improving access to dental services for underprivileged children in Texas. It is apparent that we are reverting back into the initial circumstances that originally brought the Frew law to life.

Historical Ratio of Texas Dentists to Children with Medicaid:

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