By Duane Tinker – The Toothcop
Dental Compliance Consultant | Former Investigator | Defender of Ethical Dentistry
🚫 When “No-Show” Becomes “No-Growth”
If you’re running a Medicaid-driven dental practice, you’ve likely felt the sting of no-shows. Maybe even today.
Patients who don’t show up for scheduled appointments cost you time, money, and morale.
But here’s the kicker: many popular no-show policies could get you in trouble with Medicaid.
I’ll show you:
- Why some no-show tactics are illegal
- How to reduce no-shows without violating Medicaid rules
- What successful, compliant offices are doing right
🧾 Why Medicaid Patients Miss Appointments (And Why You Can’t Just Boot Them)
First, let’s show some empathy. Medicaid patients often face:
- Transportation challenges
- Unpredictable work schedules
- Childcare issues
- Limited access to phones or digital reminders
Unlike private patients, Medicaid beneficiaries cannot be dismissed arbitrarily for no-shows. Doing so may:
- Violate Medicaid access-to-care requirements
- Lead to patient abandonment claims
- Trigger audits or program disqualification
Medicaid providers have a higher obligation to ensure continued access to care, especially for vulnerable populations.
❌ What You Cannot Do
Avoid these non-compliant or risky no-show policies:
- Charging Medicaid patients a no-show fee
→ Most Medicaid programs prohibit this.
- Dismissing patients after 1–2 no-shows
→ Must show attempts to re-engage, document efforts, and consider medical necessity.
- Blocking rebooking for extended periods
→ Could be construed as denial of care.
✅ What You Can Do (Legal & Ethical Strategies)
1. Double Down on Communication
- Use multiple reminders: text, email, phone
- Send a final confirmation message 24 hours before
- Consider “Yes-to-confirm” systems (patients must reply to secure their slot)
2. Offer Same-Day Appointments
- Hold open slots for rescheduling or same-day care
- Reduce risk of missed visits from long scheduling windows
3. Transportation Coordination
- Provide bus pass info, rideshare details, or Medicaid transportation options
- Have your front desk remind patients about transportation when confirming
4. Flag High-Risk Patients
- Track habitual no-shows in your system
- Overbook strategically when high-risk patients are scheduled
5. Educate Patients on Impact
- Use simple language: “When you don’t show up, another child loses a chance to see the dentist.”
- Reinforce the importance of preventive care
6. Reward Reliability
- Offer positive reinforcement like stickers for kids or thank-you cards for kept appointments
- Send a friendly follow-up message to consistent attenders
7. Formal No-Show Policy (Documented & Applied Fairly)
- Include in your compliance manual
- Have a script for staff to explain policy verbally
- Use non-punitive language: “To help us serve all families…”
📄 Document Everything
If you’re dismissing or restricting a Medicaid patient due to repeated no-shows:
- Document every missed appointment
- Note all re-engagement attempts
- Consult your state’s Medicaid policy before limiting care
- Send written communication (certified mail when necessary)
The paper trail is your best legal defense.
🧠 The Toothcop’s Take
Look, I get it—no-shows are frustrating. But in a Medicaid-driven practice, they’re also a compliance landmine if mishandled.
The solution isn’t punishment—it’s engagement, communication, and proactive management. With the right systems in place, you can minimize no-shows without risking Medicaid violations—or your sanity.
🦷 Stay sharp
Duane Tinker – The Toothcop