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. 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. 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 that provide CHIP coverage to children through a Medicaid expansion program are required to provide the EPSDT benefit. 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. 2018 Medicaid|Medicare|CHIP Services Dental Association 4411 Connecticut Avenue, N.W., #401; Washington, DC 20008 Telephone: 508-322-0557; mfoley@medicaiddental.org A direct dental referral is required for every child in accordance with the periodicity schedule set by 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). There are a plethora of questions surrounding healthcare and especially dental care in the US. Washington, D.C. 20201 Medicaid is the public health insurance program for low-income Americans. States are also required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages on InsureKidsNow.gov. 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. Medicaid and CHIP offer free or low-cost health insurance for kids and teens. 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. 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. Dental Services for Adults. It is a federal program for low-income families administered locally. While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. 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. 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. A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state. 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. 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. 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. Whether you will have dental coverage under Medicaid depends on if your state has decided to provide that coverage or not. See article in New York Times, August 2, 2018, "Lack of Dental Coverage Hampers Medicaid Recipients, Suit Says." For additional information on the Arkansas Medicaid Dental Fee for Service program, enrollees can call the assistance line at 501-320-6230. Dental services may not be limited to emergency services for EPSDT recipients. 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. Each topic nomination is reviewed and researched by a Medicaid medical or dental benefits policy analyst. EPSDT is a mandatory service required to be provided under a state's Medicaid program. 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). 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. U.S. Department of Health & Human Services Before sharing sensitive or personal information, make sure you’re on an official state website. 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. 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 The program's focus is on prevention, early diagnosis,  and treatment of medical conditions. 200 Independence Avenue, S.W. Toll Free Call Center: 1-877-696-6775​, U.S. Department of Health & Human Services. Does Washington Medicaid Cover Dental? 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. 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. The webinar materials are available below. An official website of the United States government. 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. 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. NEW CASTLE (Sept. 29, 2020) – Adult Delawareans who receive Medicaid will automatically get dental coverage as part of their plan starting Oct. 1. St Regis Mohawk Tribe Dental Clinic Health Services Building 404 State Route 37 Akwesasne, New York 13655 518-358-3141; Western NY Area. Dental Coverage and Plans. The Academy of Pediatric Dentistry (AAPD) recommends all children see a dentist by 12 months of age. EPSDT is a mandatory service required to be provided under a state's Medicaid program. Two Dental Managed Care carriers manage the Arkansas Medicaid Dental program: Managed Care of North America, Inc. (MCNA) – www.mcnaar.net Please print, copy, link to and share. Medicaid dental coverage for adults varies by the type of service that you need and where you live. Dental care is an important part of your overall health. Please print, copy, link to and share. Dental services are available out-of-plan, meaning, not paid for by the health plan a person is enrolled in. 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. Contact Information. Dental services for children. States determine medical necessity. Though oral screening may be part of a physical exam, it does not substitute for a dental examination performed by a dentist. 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. 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. When to buy a dental plan. 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 a state's Medicaid plan. There are no minimum requirements for adult dental coverage. 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). This is the official informational website of NY State of Health The Official Health Plan Marketplace. Medicaid Adult Dental Benefits Coverage by State . 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. 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.