Safety net dental clinics are typically paid on a fee-for-service basis, but they also may be paid on a fee-per-visit or fee-per-covered member basis. The major sources of patient care revenue for safety net dental clinics are

• Public programs (Medicaid, SCHIP, and public and private nonprofit program contracts)
• Private pay (full pay, sliding fee scale or other reduced-fee arrangements, and minimum)
• Commercial insurance (indemnity and managed care)

These different types of revenue sources are explained in more detail below.

Medicaid
Medicaid is the joint federal-state program that provides health insurance to individuals with low incomes. Medicaid programs may be operated as traditional fee-for-service, capitation, or a combination of the two. In Ohio, Medicaid is administered by the Ohio Department of Job and Family Services. Services are provided under a combination of fee-for-service and managed care plans.

Although Medicaid program designs and fee levels vary from state to state, Medicaid is generally viewed differently by private dental offices than by safety net dental clinics. Relative to their alternatives of full-fee patients and indemnity-insurance patients, most private dentists do not consider Medicaid reimbursement desirable. Consequently, most private dentists choose not to participate in Medicaid. On the other hand, Medicaid is often the primary source of reimbursement for safety net dental clinics.

State Children’s Health Insurance Program
SCHIP was designed to help states cover more children and adolescents who lack insurance. Under SCHIP, states can extend coverage to children and adolescents ages 18 and under who lack insurance if these children and adolescents do not qualify for Medicaid and their family income is low enough. Some states have expanded their existing Medicaid programs, and some have created SCHIP programs outside Medicaid. Ohio has expanded its existing program and offers coverage through Healthy Start.

Public and Private Nonprofit Program Contracts
Safety net dental clinics may enter into contracts to provide clinical services to specific groups (e.g., correctional institutions, employment services agencies, Head Start programs) that are otherwise served by public or private nonprofit agencies. The clinic receives payment according to the terms of the contract.

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