Beyond Coverage: Removing the Barriers That Keep Medicaid Members from Care

Medicaid dental coverage is essential, but coverage alone does not guarantee access.

Many members still face barriers that can delay or prevent care, including provider shortages, transportation challenges, language needs, limited health literacy, and difficulty finding providers equipped to serve individuals with complex or specialized needs. 

For Medicaid agencies and managed care organizations, improving access means looking beyond network size and asking a more practical question:

Can members actually find and reach the right care when they need it?
 

Finding the Right Provider Matters

Approximately 76 million Americans live in Dental Health Professional Shortage Areas, highlighting the scale of the access challenge.

For underserved populations, proximity alone may not be enough. Members may also need providers with specific expertise, appropriate accessibility accommodations, language capabilities, or experience serving individuals with special healthcare needs.

SKYGEN's Find-A-Provider capabilities help members search for in-network care by factors such as location, specialty, and availability, making it easier to connect with providers who can meet their needs.  SKYGEN is also working toward more advanced search capabilities that consider factors such as public transportation, languages, accessibility accommodations, and experience serving specialized populations. 

Helping Members Avoid Unnecessary Emergency Room Visits

When members cannot find timely dental care, the emergency room can become the default option. Approximately 1.3 million emergency department visits occur each year for non-traumatic dental conditions, resulting in more than $1 billion in annual healthcare costs. 

The problem is that emergency rooms are not designed to provide definitive dental treatment. Members may receive temporary relief without addressing the underlying condition, creating a costly cycle without improving long-term oral health. 

SKYGEN's Emergency Room Diversion Program addresses this challenge by identifying members who use emergency departments for non-emergent dental conditions and providing timely outreach to connect them with more appropriate care. Using near real-time data sources such as Health Information Exchanges, Admission, Discharge and Transfer feeds, and health plan partnerships, the program can engage members while the event is still recent. 

Members receive education, help locating an in-network provider, and support establishing a dental home, with the goal of improving future care-seeking behavior and reducing avoidable emergency room use. 

Expanding Access Through Virtual Care

Virtual care can provide another important pathway for members facing transportation barriers, provider shortages, scheduling challenges, or geographic limitations.

SKYGEN's virtual visit solution gives members access to dental guidance, triage, education, referrals, and follow-up support without requiring unnecessary travel. It can also support emergency room diversion by giving members with dental pain another option for determining the next appropriate step. 

Research has shown that tele-dentistry models in underserved areas have demonstrated a 25% reduction in emergency dental visits alongside increased preventive care utilization. 

Access Requires More Than Coverage

Improving Medicaid dental access means removing the barriers that stand between members and appropriate care.

That can include helping members identify the right provider, intervening before emergency room use becomes a pattern, and creating additional pathways to care when traditional access is limited.

For underserved populations, these improvements can make the difference between having a benefit on paper and actually receiving the care that benefit is intended to provide.

SKYGEN helps Medicaid agencies and managed care organizations create more connected access strategies that support earlier care, better navigation, and stronger outcomes for the populations they serve.

To learn more about how we can help, connect with our Medicaid team!