The Michigan Department of Health and Human Services (MDHHS) has expanded dental benefits for adult Medicaid beneficiaries to improve access to dental services.
According to a statement from the department, the goal of the redesign in benefits is to help beneficiaries by increasing access to services, enhancing care coordination, improving health outcomes and incentivizing providers to treat Medicaid beneficiaries.
The department invested $85.1 million in increased reimbursement and $30 million in redesigned benefits. The benefit enhancement and service delivery began on April 1, 2023.
“This positive change recognizes the strong correlation between oral and physical health outcomes,” said Elizabeth Hertel, MDHHS director. “With better services and closer care coordination, we can maximize opportunities to create healthy outcomes for beneficiaries of all ages while also expanding the number of providers so Michigan’s residents can get care where and when they need it.”
According to MDHHS, this change will not result in any kind of loss of service, but many recipients could have new services added.
The following services are covered for Medicaid beneficiaries who are 21 years and older:
- X-rays
- Teeth cleanings
- Fillings
- Extractions
- Dentures
- Deep teeth cleanings (new)
- Sealants (new)
- Root canals (new)
- Crowns (new)
- Care to keep your gums healthy (new)
One of the first steps the department took in the redesign of these benefits was implementing a policy that increased reimbursement rates for Medicaid dental service providers to improve beneficiary access and provider participation.
The policy was implemented on Jan. 1, 2023, and, according to MDHHS, providers are now being paid at 100% of the Average Commercial Rate. This ensures beneficiaries are supported in accessing the services they need and is an incentive for providers to treat Medicaid beneficiaries.
“The reimbursement rates for providers were very low under the old adult dental Medicaid program,” said Dr. Vince Benivegna, President of the Michigan Dental Association. “Dentists would lose money by treating adult dental Medicaid patients. As small business owners this was not sustainable. The new rates recognize the value of quality care and will allow more dental health providers to treat Medicaid patients.”
Although beneficiaries will not lose any benefits, MDHHS says the way services are delivered may change slightly.
Here’s the information from MDHHS about those slight changes:
Medicaid beneficiaries aged 21 years and older, including Healthy Michigan Plan beneficiaries and pregnant women who are enrolled in a Medicaid Health Plan, Integrated Care Organization or Program of All-Inclusive Care for the Elderly will receive dental benefits through their health plan. The health plan becomes responsible for the beneficiary’s dental services obtained through the health plan’s dental provider network. The health plans will continue to provide robust care coordination and ensure that beneficiaries are supported in accessing the services they need.
Dental services for beneficiaries who are not enrolled in a health plan will be provided through the Medicaid FFS program.
Michigan Department of Health and Human Services
Any beneficiaries with questions can call the Beneficiary Help Line at 800-642-3195 or can email beneficiarysupport@michigan.gov. Providers with questions should call 800-292-2550 or email providersupport@michigan.gov.