DenQAI decision lab
Medicaid economics
Stress state-level fee benchmarks, benefit scope, utilization, attendance, claims, administration, and cash timing.
The governing test
The governing testWhich source or constraint could change this result?- Clear the non-negotiable gates.
- Normalize capacity, cash, and clinical transfer.
- Price workforce and payer friction as operating facts.
Fictional example
Model v3.2.0Results use the entered assumptions. Evidence and safety checks still require review.
No input edits yet. Unchanged example values remain fictional assumptions. No changes since the last download or opening state.
Assumptions, evidence still needed, and local saving
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Planning case — assumptions and evidence require review. Includes fictional example assumptions. Formula v3.2.0.
Blank means unknown. Enter 0 only for a known zero or an item that does not apply and has no cost or use. Example values and modeled estimates are assumptions until supported by your records.
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.
If the selected fee comparator is not reported, modeled collections and dependent cash results are unavailable. Missing evidence is not a zero reimbursement rate.
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 |
Frozen ADA extract with mixed 2022–2025 observations. The December 2025 report and September 2025 fee-basket period are distinct; individual rows were not re-extracted in this review. Verify current code-level schedules, benefits, and your contract.
Next action
Use the result to request the missing evidence.
Verify current benefits, code-level fees, the exact delivery system and contract, then test observed service-to-cash timing and reserves.
Model payer cash continuityRecord the source, period, responsible reviewer, and assumption that would change your decision in the case review note.