A recent report shows that the Georgia agency responsible for Medicaid has failed to adopt or follow most prior audit recommendations intended to improve dental care access for children, including those with disabilities, causing the utilization rate to worsen. (Luis Alvarez/Getty)
A state agency responsible for administering Medicaid in Georgia has failed to adopt or follow through on most of the recommendations made in an earlier audit that were meant to help more children, including those with disabilities, obtain dental care, according to a recent report.
Despite a 2021 state audit that highlighted falling dental care utilization among a group of Georgia children enrolled in Medicaid, a recent follow-up review found that the situation has worsened.
The 2021 report identified a downward trend in the percentage of children covered by Fee-for-Service Medicaid who received dental care, with it dropping from 44% to 33% over a three-year period. An August report found that this decline has continued.
Participation had fallen further to a new low of 28% in budget year 2024, with the review attributing this decline to a lack of coordinated, data-driven management by DCH.
“DCH was unaware of this trend because it did not routinely analyze claims to evaluate services provided and identify differences between subpopulations and geographic areas,” the 2025 audit stated. “The lack of a data-driven management approach also limited DCH’s ability to develop informed strategies to address deficiencies.”
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According to data from DCH, an average of nearly 100,000 children receiving Medicaid benefits, or about 6%, were enrolled in the Fee-for-Service program between January 2021 and August 2025. However, this relatively small population largely represents children who are disabled or receive specialized care.
Georgia administers Medicaid benefits through two different models: Fee-for-Service and managed care organizations. For those enrolled in Fee-for-Service Medicaid, also known as traditional Medicaid, the state directly pays health care providers, including dentists, a fee for each service they provide. For Medicaid plans provided through managed care organizations, known in Georgia as care management organizations, the state pays a fee to a private insurance company that then manages the patient’s care.
This year’s follow-up review found that the main issues identified in the 2021 audit remain largely unresolved.
The report found that DCH has since discontinued its quarterly reviews of dental claims data and abandoned “secret shopper” calls, which were meant to assess whether providers were offering appointments to new patients without long wait times. The state agency has also not established utilization goals for its children’s program, nor has it fully analyzed provider networks to accurately reflect the number of dentists accepting new patients, the audit found.
David Crews, chair of the Board of Community Health’s audit committee, noted the limited progress at the panel’s September meeting. He said the department has “developed a structured and strategic approach to ensure a sustained effort to address these findings and bring the resources necessary to address the findings.” Crews did not provide details on these efforts.
The state “partially addressed” efforts to increase participation from dental care providers in the Medicaid dental program, according to the audit. Although the General Assembly passed a new law last year offering loan forgiveness to dental students who practice in underserved areas, it’s not clear whether the Department of Community Health has specifically used this program to boost the number of dentists in its Fee-For-Service network, according to the follow-up review.
The state has fully addressed a key recommendation to provide more comprehensive dental coverage for adults, which the General Assembly targeted by funding full dental benefits for adults starting in last year’s budget.
Rena Harris, chief program officer for the Georgia Council on Developmental Disabilities, said in an interview that the audit identified historical issues in the state’s Fee-for-Service program, such as lower provider reimbursement rates than those in a care management organization. She also said the audit encouraged the state agency to adopt procedures in place for care management organizations to help increase access to Medicaid-covered dental services for children with disabilities.
The agency initially adopted some procedures to address concerns raised in the 2021 audit but eventually “abandoned” those efforts, according to the audit review. The agency, for example, began analyzing Fee-for-Service dental claims and enrollment data trends, but that was eventually discontinued. The review further states that DCH has not shared those findings with a policy compliance specialist assigned to its dental program.
“That’s what the children need. So if they reimplement these processes that halted, that will result in children who receive Fee-for-Service dental care having better access, which will hopefully bring their services on par with the children who receive services through CMO,” Harris said.
Harris said she was encouraged to see DCH’s response in the audit. She said that while DCH did not follow through on earlier recommendations, the agency has since shown accountability and appears “open to restarting the processes that were halted,” some of which were likely affected by the COVID-19 pandemic. The 2021 audit noted that dental services expenditures in both Fee-for-Service and managed care declined in fiscal year 2020, likely due to reduced overall utilization of health care services during the COVID-19 pandemic.
“It’s difficult to fully comprehend all of the challenges that were faced during that time, and I know that our state government and our state agencies were incredibly stressed during that time, especially the state agencies that were responsible for people’s health and safety,” Harris said.
