MassHealth Appeal

To the valued patients of Berkshire Pediatric Dentistry (BPD) and their families:

Unfortunately, due to skyrocketing costs of Personal Protective Equipment coupled with MassHealth’s failure to increase reimbursement for pediatric dental offices since 2009, our practice has no choice but to stop accepting MassHealth effective January 1, 2022. At the current reimbursement level, we would not be able to keep our office open and continue to provide care at the level we have come to expect of ourselves with materials we trust.

These are decisions we do not take lightly. For the past year, we have had discussions with the Director of MassHealth as well as with our state representative. We have advocated tirelessly for our patients and community; however, we do not foresee significant change in the near future. We encourage you to take action and contact your state representative and/or MassHealth to let them know that change is needed. We will provide a template for advocacy and other helpful information below. We hope that with the help of our community, we can enact meaningful change.

Offering care to patients with MassHealth is important to us and we will continue to advocate for children in Berkshire County. We hope that our combined efforts will encourage MassHealth to take action and that we will be able to provide care again for all children in our community.

Template for Advocacy

Dear [insert name],

[Add personalization here. You could discuss difficulty finding another pediatric dentist if you’re leaving our office, why you think changes are necessary so you can stay at our office, or information regarding difficulty getting care.]

Public health programs were created and funded in an attempt to act as a safety net for vulnerable sectors in society. They are an integral component of our community and help to create health equity so that everyone can thrive. Sadly, changes – or lack thereof – in MassHealth have resulted in failures of the program. The safety net now has gaping holes so large that the people it was intended to serve are falling through the gaps.

The children in the Berkshires are among those that are suffering the most.

Currently, if a family in the Berkshires is seeking a dentist for their child and has MassHealth, they will not be able to see a pediatric dentist unless they travel approximately an hour away. There are no pediatric dentists in Berkshire County employed at any of the FQHCs here. In fact, there are only two pediatric dental practices in the entire county, and neither is accepting new patients with MassHealth as their insurance. Even worse, one of the offices (Berkshire Pediatric Dentistry) had to make the incredibly difficult decision to stop participating with MassHealth altogether beginning January 1, 2022.

This situation was (and still is) entirely preventable. MassHealth has not increased its pediatric dentistry reimbursement rates since 2009. Since then, cost of living here has increased by 20% and rent by 30%. MassHealth now reimburses pediatric dentists at 1/3-1/2 of the typical fee schedule. As much as offices like Berkshire Pediatric Dentistry love their patients and hate to say goodbye to them, they simply cannot afford to keep the office open and maintain their standard of care while paying their staff the salaries they deserve if they continue to participate with MassHealth.

If MassHealth makes appropriate adjustments to its fee schedule for pediatric dentists, Berkshire Pediatric Dentistry will happily continue to participate with MassHealth.

Even more disturbing, there seems to be a coordinated effort to decrease the care that is provided to people who are participating in MassHealth. One of the preeminent, board certified orthodontists in the area has written to our local representatives to express his concerns and even gave testimony on July 16, 2021 regarding sharp decreases in the approval for orthodontia (braces) covered by MassHealth. Approval rates dropped from 70% to 23% – a statistic that was supported by the Massachusetts Association of Orthodontists in their testimony. In that hearing, Judge Sarroff concluded that in communications between MassHealth administrators revealed that they were “aware that the instructional changes would cause approvals to drop.” Essentially, there was a deliberate effort to decrease the approval for care that the children here desperately need.

If changes to MassHealth are not implemented quickly, the children in the Berkshires will suffer even more. It is unfair for them to face such insurmountable barriers for access to care and even more shameful that there has been a coordinated effort to deny them access to the orthodontic care they require for healthy oral development.

I strongly urge you to make changes to MassHeath’s dental plan – particularly for children – an immediate priority.

Thank you,

[Your Name]

Contact Information:

  • State Representative Tricia Farley-Bouvier

    Phone: (617) 722-2240

  • State Representative Smitty Pignatelli

    Phone: (617) 722-2210

  • State Representative John Barrett, III

    Phone: (617) 722-2305

  • State Representative Paul Mark

    Phone: (617) 722-2692

  • Senator Adam Hinds

    Phone: (617) 722-1625

  • Mass Health Representative

    Phone: (800) 207-5019

  • U.S. Senator Elizabeth Warren

    Phone: (413) 788-2690
    Office of Senator Warren
    United States Senate
    Washington, D.C. 20510

  • U.S. Senator Ed Markey

    Phone: (413) 785-4610
    Office of Senator Markey
    United States Senate
    Washington, D.C. 20510

Old Template for Advocacy

Dear [State Representative/Senator/MassHealth Representative],

MassHealth has not increased their reimbursement for children’s dentistry since 2009 (with the exception of a crown code in 2012). Since 2009, cost of living has increased over 20% and average rent has increased almost 30% in Massachusetts. At the very least, MassHealth needs to keep up with inflation. Furthermore, since the start of the COVID-19 pandemic, Personal Protective Equipment (PPE) requirements and costs have skyrocketed, forcing many dental offices to limit or stop accepting insurance plans that offer low reimbursements since they no longer cover the costs of care. Government sponsored insurance is supposed to make healthcare accessible to everyone, but that can only be the case when local providers accept that plan.

We are asking for you to champion an across the board increase in MassHealth fees for children to allow dental offices to continue to accept MassHealth.

Our children deserve more.


[Your name here}