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. Phone: 855-934-9812 2. EPSDT is Medicaid's comprehensive child health program. NH Medicaid is a federal and state funded health care program that serves a wide range of needy individuals and families who meet certain eligibility requirements. Adult dental coverage is optional for state Medicaid programs, but most offer at least an emergency dental benefit. Dental services are available out-of-plan, meaning, not paid for by the health plan a person is enrolled in. 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. St Regis Mohawk Tribe Dental Clinic Health Services Building 404 State Route 37 Akwesasne, New York 13655 518-358-3141; Western NY Area. How can I change my dental coverage plan? 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. Adult dental coverage is optional for state Medicaid programs, but most offer at least an emergency dental benefit. 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. 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. 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. Dental; Dental Plans and Program; Dental Plans and Program . Each state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health care. 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. The adult dental benefit is available to eligible adult Health First Colorado members (21 and over) and covers: Enroll in a dental-only plan or add dental when you buy a health plan. Dental Coverage and Plans. 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. Whether you will have dental coverage under Medicaid depends on if your state has decided to provide that coverage or not. Some states offer only limited dental coverage, and some do not offer dental coverage at all. The Academy of Pediatric Dentistry (AAPD) recommends all children see a dentist by 12 months of age. Beginning Oct. 1, […] The RI Medicaid Program provides dental services to children and adults over age 21 who have Medicaid coverage. EPSDT is a mandatory service required to be provided under a state's Medicaid program. 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. 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. 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. A direct dental referral is required for every child in accordance with the periodicity schedule set by the state. It also suggests opportunities for states to increase oral health care coverage and access for this population. Please print, copy, link to and share. We are also ramping up our efforts to educate consumers, health care providers and the public about positive oral health practices. 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.". Covered services for adults are different from covered services for children. See article in New York Times, August 2, 2018, "Lack of Dental Coverage Hampers Medicaid Recipients, Suit Says." 2018 Medicaid|Medicare|CHIP Services Dental Association 4411 Connecticut Avenue, N.W., #401; Washington, DC 20008 Telephone: 508-322-0557; [email protected] For additional information on the Arkansas Medicaid Dental Fee for Service program, enrollees can call the assistance line at 501-320-6230. Dental services are a required service for most Medicaid-eligible individuals under the age of 21, as a required component of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Find Coverage for Your Family. U.S. Department of Health & Human Services Also available are tips for using the materials. 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. These fact sheets give information about dental coverage. States are also required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages on InsureKidsNow.gov. It is a federal program for low-income families administered locally. States that provide CHIP coverage to children through a Medicaid expansion program are required to provide the EPSDT benefit. Georgia Medicaid Dental Coverage As mentioned, dental benefits are not covered nationally in Medicaid and are optional in-state programs. Implementation was originally scheduled for April 2020, but was delayed by the coronavirus pandemic. Dental services may not be limited to emergency services for EPSDT recipients. Does Washington Medicaid Cover Dental? Medicaid Adult Dental Benefits Coverage by State . 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. The Center for Medicaid and CHIP Services at the Centers for Medicare & Medicaid Services is hosting a series of webinars to support States and their collaborative partners to improve access to dental services for children enrolled in Medicaid and CHIP. 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. Illinois Dental Medicaid Program. Eastman Dental General Dentistry, Periodontics, Prosthodontics, orthodontics, pediatric and urgent dental care 625 Elmwood Avenue Rochester NY 14620 585-275-5051 The Rhode Island Medicaid Program provides dental services for people with Medicaid coverage. There are a plethora of questions surrounding healthcare and especially dental care in the US. NEW CASTLE (Sept. 29, 2020) – Adult Delawareans who receive Medicaid will automatically get dental coverage as part of their plan starting Oct. 1. See the Children's Dental Benefits page for more information about benefits for Health First Colorado members under age 21. 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. Oral health (dental care) is an important component of overall health. 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.. 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. What does the dental benefit cover? States determine medical necessity. 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. Select your state to find information on health insurance programs in your state or call 1-877-KIDS-NOW (1-877-543-7669). 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. Before sharing sensitive or personal information, make sure you’re on an official state website. These fact sheets give information about dental coverage. To sign up for updates or to access your subscriber preferences, please enter your contact information below. While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. 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. This is the official informational website of NY State of Health The Official Health Plan Marketplace. 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 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 Apple Health (Medicaid) pays for covered dental services for eligible children, age 20 and younger. An official website of the United States government. 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). Medicaid Adult Dental Coverage in Florida. The periodicity schedule for other EPSDT services may not govern the schedule for dental services. 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. Dental Services for Adults. Dental services are a program benefit for enrolled Health First Colorado (Colorado's Medicaid Program) members of all ages. When to buy a dental plan. Members may choose to download a copy of the Member Handbook, or contact Member Services to request a hard copy to be sent by mail.Maryland Healthy Smiles Member Services: 1. All dental services are provided through a dental plan starting December 1, 2018. 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. 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. Medicaid is the public health insurance program for low-income Americans. It also highlights There are no minimum requirements for adult dental coverage. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. State of Georgia government websites and email systems use “georgia.gov” or “ga.gov” at the end of the address. 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. Dental services must be provided at intervals that meet reasonable standards of dental practice, and at such other intervals, as indicated by medical necessity, to determine the existence of a suspected illness or condition. States must consult with recognized dental organizations involved in child health care to establish those intervals. 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. States have flexibility to determine what dental benefits are provided to adult Medicaid enrollees. 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. States may elect to provide dental services to their adult Medicaid-eligible population or, elect not to provide dental services at all, as part of its Medicaid program. Coverage for adults is at the state's discretion. 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. 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. Dental services for children. See below for more detail. Services must include at a minimum, relief of pain and infections, restoration of teeth and maintenance of dental health. 200 Independence Avenue, S.W. A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state. To support continued progress, in 2010 CMS launched the Children's Oral Health Initiative and set goals (PDF, 283 KB) for improvement by FFY 2015. Call our help line. Web Portal: http://member.mdhealthysmiles.com/ 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. TDD: 855-934-9816 3. 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 … Dental services must be provided at intervals that meet reasonable standards of dental practice, as determined by the state after consultation with recognized dental organizations involved in child health, and at such other intervals, as indicated by medical necessity, to determine the existence of a suspected illness or condition. For more information about the CMS Oral Health Initiative and the CMS Learning Lab webinars, see the June 2012 Informational Bulletin (PDF, 141.41 KB). Florida Medicaid dental plans pay for dental services. Under the Medicaid program, the state determines medical necessity. 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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