See below for more detail. Dental health is an important part of people's overall health. Completed SOHAPs may be submitted to Andrew Snyder, Health Insurance Specialist via email to [email protected] with a copy to your CMS Regional Office contact. The periodicity schedule for other EPSDT services may not govern the schedule for dental services. Select your state to find information on health insurance programs in your state or call 1-877-KIDS-NOW (1-877-543-7669). CMS has received SOHAPs from the following 25 states: Alabama (PDF, 107.08 KB), Alaska (PDF, 244.22 KB), Arizona (PDF, 113.69 KB), California, Connecticut, District of Columbia (PDF, 109.51 KB), Delaware (PDF, 200.96 KB), Florida (PDF, 750.87 KB), Maine, Maryland (PDF, 212.48 KB), Massachusetts (PDF, 223.8 KB), Michigan (PDF, 103.42 KB), Missouri (PDF, 343.93 KB), Nebraska, New Hampshire (PDF, 434.96 KB), New Jersey (PDF, 189.37 KB), North Dakota (PDF, 155.74 KB), Oklahoma (PDF, 150.99 KB), Pennsylvania (PDF, 370.38 KB), Tennessee (PDF, 260.59 KB), Utah (PDF, 111.97 KB), Vermont (PDF, 277.15 KB), Virginia (PDF, 172.7 KB), Washington (PDF, 122.59 KB) and Wyoming (PDF, 104.23 KB). Though oral screening may be part of a physical exam, it does not substitute for a dental examination performed by a dentist. From 2007 to 2011, almost half of all states (24) achieved at least a ten percentage point increase in the proportion of children enrolled in Medicaid and CHIP that received a preventive dental service during the reporting year. Whether you will have dental coverage under Medicaid depends on if your state has decided to provide that coverage or not. Coverage. The new dental benefit provides Medicaid members up to $1,000 in dental services per state fiscal year which runs from July 1 – June 30. the new adult dental benefit covers This document is a companion to the fact sheet, Medicaid Adult Dental Benefits: An Overview, which outlines states’ coverage of dental benefits for adults in Medicaid. It provides an overview of the children's dental benefit in Medicaid, support for evidence-based policies at the state level, and details of successful strategies with state examples. Dentures may be replaced based upon medical necessity; dentures and partial plates must be prior authorized by the State. 200 Independence Avenue, S.W. CMS encourages the remaining 29 states to develop and submit their SOHAPs, and CMS stands ready to provide technical assistance to any state that requests it. Before sharing sensitive or personal information, make sure you’re on an official state website. States have flexibility to determine what dental benefits are provided to adult Medicaid enrollees. Dental Services for Adults. Medicaid Adult Dental Benefits Coverage by State . Dental services may not be limited to emergency services for children entitled to EPSDT. Dental services for children must minimally include: The EPSDT benefit requires that all services must be provided if determined medically necessary. TDD: 855-934-9816 3. Anthem Member Services: 866-805-4589 Colorado Child Health Plan Plus Member Services: 888-307-6561 DentaQuest Member Services: 844-254-9490 TTY Number: 800-466-7566 Health First Colorado Member Services: 855-225-1729 Health First Colorado Provider Relations/Services: 855-225-1731 PAR line: 855-225-1947; TTY: AT&T Relay Service 711 A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state. In 2013, the state legislature passed Senate Bill 242 which authorized the Department to create a new limited dental benefit in Medicaid for adults age 21 and over. The Centers for Medicare & Medicaid Services does not further define what specific dental services must be provided, however, EPSDT requires that all services coverable under the Medicaid program must be provided to EPSDT recipients if determined to be medically necessary. There are no minimum requirements for adult dental coverage. Dental care is a covered service for eligible Medicaid members who are pregnant, disabled, blind, age 65 or older, or qualify for Early Periodic Screening, Diagnostic and Treatment (EPSDT).Learn more about dental benefits here.. Illinois Dental Medicaid Program. Call our help line. It also highlights The benchmark dental package must be substantially equal to the (1) the most popular federal employee dental plan for dependents, (2) the most popular plan selected for dependants in the state's employee dental plan, or (3) dental coverage offered through the most popular commercial insurer in the state. Dental services for children. Dental; Dental Plans and Program; Dental Plans and Program . The Academy of Pediatric Dentistry (AAPD) recommends all children see a dentist by 12 months of age. Please print, copy, link to and share. To achieve those goals, we have adopted a national oral health strategy through which we are working diligently with states and federal partners, as well as the dental provider community, children's advocates and other stakeholders to improve children's access to dental care. Find Coverage for Your Family. Adult Dental Coverage This flyer provides an overview of dental services for all adults age 21 and older covered by Washington Apple Health (Medicaid). A referral to a dentist is required for every child in accordance with each State's periodicity schedule and at other intervals as medically necessary. Local, state, and federal government websites often end in .gov. Washington, D.C. 20201 If a condition requiring treatment is discovered during a screening, the state must provide the necessary services to treat that condition, whether or not such services are included in the state's Medicaid plan. If you need assistance finding a dentist, please call a Medicaid Health Program Representative (HPR) at 1-866-608-9422. The Kaiser Family Foundation website provides in-depth information on key health policy issues including Medicaid, Medicare, health reform, global health, HIV/AIDS, health insurance, the uninsured … The adult dental benefit is available to eligible adult Health First Colorado members (21 and over) and covers: You can buy a dental-only plan or a health plan that includes dental on Maryland Health Connection during open enrollment Nov. 1 to Dec. 15. The program's focus is on prevention, early diagnosis, and treatment of medical conditions. EPSDT is Medicaid's comprehensive child health program. What does the dental benefit cover? Dental Coverage and Plans. When to buy a dental plan. An official website of the United States government. States are also required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages on InsureKidsNow.gov. People on Medicaid will get services using one or more of these plan types: EPSDT is a mandatory service required to be provided under a state's Medicaid program. To find a dental plan, use a computer and go to www.flmedicaidmanagedcare.com or call 1-877-711-3662 to talk to a Florida Medicaid Choice Counselor. This fact sheet identifies key challenges related to oral health care access and utilization for low-income adults, and outlines states’ current coverage of dental benefits for adults in Medicaid. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. Dental services are available out-of-plan, meaning, not paid for by the health plan a person is enrolled in. Covered services for adults are different from covered services for children. Phone: 855-934-9812 2. See the Children's Dental Benefits page for more information about benefits for Health First Colorado members under age 21. The webinar materials are available below. There are a plethora of questions surrounding healthcare and especially dental care in the US. While most states provide at least emergency dental services for adults, less than half of the states provide comprehensive dental care. For additional information on the Arkansas Medicaid Dental Fee for Service program, enrollees can call the assistance line at 501-320-6230. See the 2010 Medicaid/CHIP Oral Health Services fact sheet (PDF, 49.06 KB) for information on children's access to dental services and opportunities and challenges to obtaining care. State of Georgia government websites and email systems use “georgia.gov” or “ga.gov” at the end of the address. The RI Medicaid Program provides dental services to children and adults over age 21 who have Medicaid coverage. Please print, copy, link to and share. Medicaid and CHIP offer free or low-cost health insurance for kids and teens. St Regis Mohawk Tribe Dental Clinic Health Services Building 404 State Route 37 Akwesasne, New York 13655 518-358-3141; Western NY Area. It also suggests opportunities for states to increase oral health care coverage and access for this population. 2018 Medicaid|Medicare|CHIP Services Dental Association 4411 Connecticut Avenue, N.W., #401; Washington, DC 20008 Telephone: 508-322-0557; [email protected] Dental services are a program benefit for enrolled Health First Colorado (Colorado's Medicaid Program) members of all ages. The topic of Medicare and Medicaid dental coverage causes a lot of confusion for people looking for a way to help pay for dental work. Some states offer only limited dental coverage, and some do not offer dental coverage at all. Does Washington Medicaid Cover Dental? For people who meet eligibility requirements, Washington Apple Health provides coverage for services such as preventive care, cancer screening tests, care and treatment for diabetes and hypertension, as well as other conditions. Medicaid covers dental services for all child enrollees as part of a comprehensive set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Services must include at a minimum, relief of pain and infections, restoration of teeth and maintenance of dental health. Medicaid is the public health insurance program for low-income Americans. Beginning Oct. 1, […] These fact sheets give information about dental coverage. And even if you do find low-cost dental care, it can be difficult to find dentists that accept Medicaid or dentists that provide low-income options. Three oral health education materials, with messaging targeted to parents of young children and to pregnant women, are available for download or bulk order. To sign up for updates or to access your subscriber preferences, please enter your contact information below. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. Enroll in a dental-only plan or add dental when you buy a health plan. States with a separate CHIP program may choose from two options for providing dental coverage: a package of dental benefits that meets the CHIP requirements, or a benchmark dental benefit package. Overall, dental insurance coverage is much less prevalent than medical insurance in the United States. To support state Medicaid and CHIP programs in achieving their improvement goals, we developed Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents (PDF, 578.09 KB). To find out more information regarding participating dental providers, covered services for children and adults, and information on school-based dental services visit the Illinois Department of Healthcare and Family Services webpage. The federal government sets a minimum standard and gives each state the latitude to extend benefits – and many do for oral care – each in its own unique way. While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. States that provide CHIP coverage to children through a Medicaid expansion program are required to provide the EPSDT benefit. Zucker (18-cv-06945) to challenge the New York State Department of Health’s rules preventing Medicaid coverage for replacement dentures within 8 years from initial placement and the ban on Medicaid coverage for dental implants. Florida Medicaid covers the following emergency-based dental Medicaid services: Limited exams and X-rays, dentures, teeth extractions, sedation, problem-focused care and pain management. SOHAPs may be submitted using either a CMS-developed Oral Health Action Plan Template or a user-friendly template developed by the Medicaid-CHIP State Dental Association. Contact Information. Toll Free Call Center: 1-877-696-6775, U.S. Department of Health & Human Services. To support the Oral health Initiative, CMS invited state Medicaid agencies to develop State Oral Health Action Plans (SOHAPs) as a roadmap to achieving in their goals. Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents (PDF, 578.09 KB), Improving Oral Health Care Delivery in Medicaid and CHIP: A Toolkit for States (PDF, 2.46 MB), Innovative State Practices for the Provision of Dental Services in Medicaid (PDF, 132.55 KB). Info: There may be a copayment for dental services of $3 per visit for non-pregnant individuals age 21 and older who are not residing in a nursing facility or intermediate care facility for people with mental retardation. Web Portal: http://member.mdhealthysmiles.com/ Dental services may not be limited to emergency services for EPSDT recipients. See article in New York Times, August 2, 2018, "Lack of Dental Coverage Hampers Medicaid Recipients, Suit Says." Eastman Dental General Dentistry, Periodontics, Prosthodontics, orthodontics, pediatric and urgent dental care 625 Elmwood Avenue Rochester NY 14620 585-275-5051 recent survey of Medicaid dental program managers by the National Academy for State Health Policy (NASHP) and the Medicaid-SCHIP Dental Association is the source of this update on the status of states’ Medicaid coverage of adult dental services. Coverage starts Jan. 1. Adult dental coverage is optional for state Medicaid programs, but most offer at least an emergency dental benefit. Keeping your teeth, mouth, and gums clean and healthy can help you avoid disease and maintain good health throughout your lifetime. This is the official informational website of NY State of Health The Official Health Plan Marketplace. Home > Answers > Medicare & Medicaid > Does Medicaid cover dental care? The Rhode Island Medicaid Program provides dental services for people with Medicaid coverage. Oral health (dental care) is an important component of overall health. Adult dental coverage is optional for state Medicaid programs, but most offer at least an emergency dental benefit. All dental services are provided through a dental plan starting December 1, 2018. Under the Medicaid program, the state determines medical necessity. Yet, tooth decay remains one of the most common chronic childhood diseases. Florida Medicaid dental plans pay for dental services. Two Dental Managed Care carriers manage the Arkansas Medicaid Dental program: Managed Care of North America, Inc. (MCNA) – www.mcnaar.net Dental coverage in separate CHIP programs is required to include coverage for dental services "necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.". The state of Washington calls their Medicaid services program "Washington Apple Health." Each topic nomination is reviewed and researched by a Medicaid medical or dental benefits policy analyst. Each state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health care. Coverage for adults is at the state's discretion. It has been a long-standing priority of DMMA to offer preventive and restorative dental treatment for our adult population to address negative health outcomes associated with the lack of oral health care. States must consult with recognized dental organizations involved in child health care to establish those intervals. The benchmark dental package must be substantially equal to the (1) the most popular federal employee dental plan for dependents, (2) the most popular plan selected for dependants in the state's employee dental plan, or (3) dental coverage offered through the most popular commercial insurer in the state. We have been making considerable progress (PDF, 303.79 KB) in our efforts to ensure that low-income children have access to oral health care. The State Overviews provide resources that highlight the key characteristics of states’ Medicaid and CHIP programs and report data to increase public transparency about the programs’ administration and outcomes. Under the Affordable Care Act (ACA), some states have chosen to expand Medicaid coverage to previously ineligible adults, but the dental coverage varies widely by state. U.S. Department of Health & Human Services States are required to provide dental benefits to children covered by Medicaid and the Children's Health Insurance Program (CHIP), but states choose whether to provide dental benefits for adults. The Centers for Medicare & Medicaid Services (CMS) is committed to improving access to dental and oral health services for children enrolled in Medicaid and CHIP. Oral screening may be part of a physical exam, but does not substitute for a dental examination performed by a dentist as a result of a direct referral to a dentist. Apple Health (Medicaid) pays for covered dental services for eligible children, age 20 and younger. Reducing Early Childhood Tooth Decay: Approaches in Medicaid – May 27, 2015, Performance Improvement Projects (PIP) for States and Health Plans - Implementation Considerations – May 20, 2015, Performance Improvement Projects (PIP) for States and Health Plans - Planning Considerations – May 6, 2015, Linking Children with Special Healthcare Needs to Dental Providers – February 18, 2015, Advancing Program Integrity for Medicaid Dental Programs: Federal, State, and Stakeholder Efforts – January 28, 2015, Improving Oral Health Through Access: Building a Partnership between Medicaid and Head Start – September 16, 2014, State Medicaid and CHIP Program Support of Sustainable Oral Health Care Delivery Models in Schools and Community-Based Settings – May 14, 2014, Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children & Adolescents - January 30, 2014, Dental Sealants: An Effective State Strategy to Prevent Dental Caries in Children - September 19, 2013, Engaging More General Dentists to Care for Young Children: Access to Baby and Child Dentistry (ABCD) in Washington and South Dakota - May 8, 2013, Quality Improvement Processes: An Introduction for Medicaid and CHIP Dental Programs - January 23, 2013, Successful Beneficiary Outreach Strategies - September 26, 2012, Developing State Oral Health Action Plan Using State Data - June 19, 2012, A federal government managed website by theCenters for Medicare & Medicaid Services.7500 Security Boulevard Baltimore, MD 21244, Medicaid Beneficiaries with Complex Care Needs and High Costs, Community Integration Through Long-Term Services and Supports, Using Section 1115 Demonstrations for Disaster Response, Home & Community-Based Services in Public Health Emergencies, Medicaid and CHIP Eligibility & Enrollment Webinars, Affordable Care Act Program Integrity Provisions, Lawfully Residing Immigrant Children & Pregnant Women, Home & Community Based Services Authorities, July 2020 Medicaid & CHIP Enrollment Data Highlights, Medicaid Enrollment Data Collected Through MBES, Performance Indicator Technical Assistance, 1115 Demonstration Monitoring & Evaluation, 1115 Substance Use Disorder Demonstrations, Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations, Seniors & Medicare and Medicaid Enrollees, Medicaid Third Party Liability & Coordination of Benefits, Medicaid Eligibility Quality Control Program, State Expenditure Reporting for Medicaid & CHIP, Actuarial Report on the Financial Outlook for Medicaid, Section 223 Demonstration Program to Improve Community Mental Health Services, Medicaid Information Technology Architecture, Medicaid Enterprise Certification Toolkit, Medicaid Eligibility & Enrollment Toolkit, SUPPORT Act Innovative State Initiatives and Strategies, SUPPORT Act Provider Capacity Demonstration, Learn How to Report the CMS 416 Dental Data, Early and Periodic Screening, Diagnostic, and Treatment, Vision and Hearing Screening Services for Children and Adolescents, Alternatives to Psychiatric Residential Treatment Facilities Demonstration, Testing Experience & Functional Tools demonstration, Medicaid MAGI & CHIP Application Processing Time, Dental Excerpt from the 2015 Secretary's Report, Medicaid Dental Trends Analysis: 2000-2012, Improving Oral Health Care Delivery in Medicaid and CHIP: A Toolkit for States, Federal Policy Guidance-Dental Coverage in CHIP, Guide to Children's Dental Care in Medicaid, Policy Issues in the Delivery of Dental Services, 2010 Eight-State Medicaid Dental Review Summary Report, AAPD State EPSDT Dental Periodicity Schedules, Find a Medicaid/CHIP Dental Provider in your State, Oral Health Care During Pregnancy: A National Consensus Statement, Tips for Good Oral Health During Pregnancy, Keep Kids Smiling Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents, 2010 Medicaid/CHIP Oral Health Services fact sheet, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents, Related Technical Assistance Brief Dental Sealant Measure, Early and Periodic Screening, Diagnostic and Treatment, Medicaid Oral Health Performance Improvement Projects: A How-To-Manual for States, Medicaid Oral Health Performance Improvement Projects: A How-To-Manual for Health Plans, Medicaid Oral Health Performance Improvement Projects: A Template, Reducing Early Childhood Tooth Decay: An Overview for State Policymakers, Reducing Early Childhood Tooth Decay: Leading Steps for State Policymakers, Reducing Early Childhood Tooth Decay: Strategies for State Medicaid and CHIP Program Managers, Innovative State Practices for the Provision of Dental Services in Medicaid, Learn how to improve the quality of the dental data reported on the Form CMS-416, the annual report of services provided to children receiving the Medicaid.
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