DenQAI decision lab
Medicaid economics
Stress state-level fee benchmarks, benefit scope, utilization, attendance, claims, administration, and cash timing.
Calculator 08
Medicaid economics and 50-state explorer
Coverage is not utilization, enrollment is not patient volume, and a fee schedule is not cash. Model all four.
South DakotaEnhanced adult benefit
Illustrative economics
Dentists enrolled, 202462%
Child utilization, 202450%
Adult utilization, 202224%
“Slow pay” needs a precise diagnosis.
42 C.F.R. § 447.45 generally requires Medicaid agencies to pay 90% of clean practitioner claims within 30 days of receipt and 99% within 90 days. Real cash can still lag because a claim is not clean, eligibility changes, documentation or imaging is missing, prior authorization fails, a managed-care plan uses different workflows, or payment is later recouped. Model observed service-to-cash days and denial/rework cost.
| State | Adult benefit | Child FFS / private | Child $ example | Adult FFS / private | Adult $ example | Child use | Adult use | Dentists enrolled | Delivery caution |
|---|---|---|---|---|---|---|---|---|---|
| None | 74% | $111 | — | — | 47% | — | 59% | FFS still requires verification | |
| Enhanced | 71% | $107 | 58% | $87 | 42% | 23% | 58% | FFS still requires verification | |
| Emergency-only | 79% | $118 | — | — | 49% | — | 24% | MCO / PAHP—verify contract | |
| Limited | 78% | $117 | 76% | $113 | 53% | 7% | 64% | MCO / PAHP—verify contract | |
| Enhanced | 59% | $89 | 68% | $102 | 50% | 18% | 33% | FFS still requires verification | |
| Enhanced | 94% | $141 | 98% | $148 | 52% | 24% | 48% | FFS still requires verification | |
| Enhanced | 80% | $120 | 50% | $74 | 57% | 26% | 43% | FFS still requires verification | |
| Limited | 126% | $190 | 116% | $175 | 53% | 11% | 76% | MCO / PAHP—verify contract | |
| Enhanced | 83% | $125 | 68% | $101 | 51% | 22% | 25% | MCO / PAHP—verify contract | |
| Emergency-only | 44% | $67 | — | — | 41% | — | 26% | MCO / PAHP—verify contract | |
| Enhanced | 64% | $96 | 61% | $92 | 46% | — | 29% | MCO / PAHP—verify contract | |
| Enhanced | 78% | $117 | 79% | $118 | 53% | 5% | 33% | FFS still requires verification | |
| Enhanced | 89% | $133 | 85% | $127 | 53% | 21% | 40% | MCO / PAHP—verify contract | |
| Enhanced | 38% | $58 | 42% | $63 | 44% | 18% | 33% | MCO / PAHP—verify contract | |
| Enhanced | 80% | $119 | 78% | $117 | 44% | 22% | 47% | MCO / PAHP—verify contract | |
| Enhanced | 47% | $70 | 45% | $67 | 46% | 23% | 76% | MCO / PAHP—verify contract | |
| Enhanced | 71% | $106 | 80% | $120 | 53% | 16% | 29% | MCO / PAHP—verify contract | |
| Enhanced | 75% | $113 | 71% | $107 | 47% | 14% | 46% | MCO / PAHP—verify contract | |
| Limited | 89% | $133 | 85% | $128 | 48% | 13% | 40% | MCO / PAHP—verify contract | |
| Enhanced | 61% | $92 | 66% | $99 | 40% | 9% | 32% | FFS still requires verification | |
| Enhanced | 90% | $135 | 87% | $130 | 58% | — | 27% | FFS still requires verification | |
| Enhanced | 85% | $128 | 60% | $90 | 50% | 29% | 43% | FFS still requires verification | |
| Enhanced | 83% | $125 | 85% | $127 | 45% | 19% | 48% | MCO / PAHP—verify contract | |
| Enhanced | 53% | $80 | 51% | $76 | 40% | 27% | 55% | MCO / PAHP—verify contract | |
| Emergency-only | 96% | $144 | — | — | 39% | — | 68% | MCO / PAHP—verify contract | |
| Limited | 105% | $157 | 122% | $183 | 40% | — | 44% | MCO / PAHP—verify contract | |
| Enhanced | 78% | $117 | 78% | $117 | 58% | 28% | 60% | FFS still requires verification | |
| Enhanced | 70% | $105 | 65% | $97 | 47% | 24% | 55% | MCO / PAHP—verify contract | |
| Emergency-only | 60% | $89 | — | — | 44% | — | 22% | FFS still requires verification | |
| Enhanced | 61% | $92 | 63% | $95 | 57% | 5% | 37% | FFS still requires verification | |
| Enhanced | 93% | $139 | 24% | $36 | 52% | 32% | 36% | MCO / PAHP—verify contract | |
| Enhanced | 60% | $89 | 62% | $93 | 54% | 20% | 59% | MCO / PAHP—verify contract | |
| Enhanced | 64% | $96 | 49% | $74 | 43% | 21% | 33% | MCO / PAHP—verify contract | |
| Enhanced | 51% | $76 | 53% | $80 | 54% | 15% | 31% | FFS still requires verification | |
| Enhanced | 73% | $110 | 72% | $109 | 35% | 10% | 53% | FFS still requires verification | |
| Enhanced | 84% | $126 | 79% | $119 | 30% | 22% | 30% | MCO / PAHP—verify contract | |
| Enhanced | 52% | $78 | 64% | $96 | 46% | 18% | 40% | FFS still requires verification | |
| Enhanced | 76% | $115 | 75% | $112 | 50% | 22% | 31% | FFS still requires verification | |
| Enhanced | 59% | $89 | 54% | $81 | 51% | 22% | 51% | MCO / PAHP—verify contract | |
| Enhanced | 69% | $103 | 66% | $99 | 44% | 18% | 27% | MCO / PAHP—verify contract | |
| Limited | 68% | $102 | 54% | $82 | 49% | 11% | 42% | FFS still requires verification | |
| Enhanced | 91% | $136 | 86% | $129 | 50% | 24% | 62% | FFS still requires verification | |
| Enhanced | 78% | $117 | 60% | $90 | 47% | — | 26% | MCO / PAHP—verify contract | |
| Emergency-only | 70% | $104 | — | — | 62% | — | 53% | MCO / PAHP—verify contract | |
| Enhanced | 78% | $117 | 81% | $122 | 50% | — | 32% | MCO / PAHP—verify contract | |
| Enhanced | 78% | $118 | 78% | $118 | 53% | 25% | 60% | FFS still requires verification | |
| Enhanced | 87% | $130 | 78% | $118 | 50% | 16% | 27% | FFS still requires verification | |
| Enhanced | 43% | $65 | 45% | $67 | 57% | 20% | 28% | FFS still requires verification | |
| Enhanced | 96% | $144 | 84% | $125 | 53% | 16% | 60% | MCO / PAHP—verify contract | |
| Enhanced | 55% | $83 | 48% | $71 | 42% | 19% | 33% | FFS still requires verification | |
| Limited | 71% | $106 | 51% | $76 | 50% | 20% | 64% | FFS still requires verification |
Method, not magic
Every output should create a diligence request.
Use adjusted production, collections, units, provider days, patients, and source reports. One percentage cannot carry the conclusion.
Separate provider, procedure family, payer, patient cohort, and month. A blended average can hide the exact thing the buyer will lose.
Run buyer-fit, staff-loss, no-show, denial, wage-reset, and entrant cases. Record the case that breaks the deal.