Cms Learning Lab: Improving Oral Health Through Access
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. The webinar materials are available below. For more information about the CMS Oral Health Initiative and the CMS Learning Lab webinars, see the .
Reducing Early Childhood Tooth Decay: Approaches in Medicaid May 27, 2015
Does Medicaid Cover Dental For Adults
Medicaid covers dental care for adults only in certain states, and each of these states chooses whether they want to provide limited, extensive, or emergency-only care. The states that currently provide at least limited dental care for their Medicaid base population are: AK, CA, CT, IA, MA, MO, NJ, NM, NY, NC, ND, OH, OR, RI, WA, WI.
What Services Are Covered
Medicaid covers breast pumps and breast feeding support during your pregnancy and after your baby is born.
You will get health care services through health plans. The health plans all have special programs for high-risk pregnancies. To learn more, go to Health Plan Information. Or call your health plan.
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How To Apply For Medicaid
Because Medicaid is administered through the state and states determine eligibility, you will need to visit your state’s Medicaid office or website to apply. When applying you will need proof of income, residency, age, citizenship and/or immigration status for every member of your household.
Contact your state Medicaid office . Getting approved for Medicaid can take time, so start the application process as soon as there is a clear need. Most offices allow you to apply or at least start your request online. You may need to go into one of their offices for an interview as part of the application process. Have all your needed verification documents ready.
Medicaids Eligibility factors include income, residency, age, citizenship, immigration status, household composition, and pregnancy.
The exact verification documents you will need will vary based on what state you are in. However, be prepared to have any proof of income, proof of residency, your social security card, and immigration status confirmation documents on hand . Generally, household composition and pregnancy status do not require formal verification.
What Changes When A Woman Already Enrolled In Medicaid Becomes Pregnant
Generally, nothing. A woman who was previously eligible and enrolled in full-scope Medicaid who becomes pregnant continues to be eligible, and will be able to access pregnancy services. A woman who becomes pregnant while enrolled in Medicaid Expansion can stay in that coverage, at least until redetermination. The state must inform the woman of the benefits afforded to pregnant women under other coverage categories, such as pregnancy-related Medicaid, and provide the option to switch categories if the woman is eligible.
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What Is Medicaid For Pregnant Women
With Medicaid for pregnant women, you get full health care benefits during your pregnancy and for two months after your babys birth. Medicaid may also cover your medical bills for the three months before you enroll. You also get dental benefits during your pregnancy. Dental services are through the Smiles for Children program. For help finding a dentist or to learn more, call Smiles For Children at 1-888-912-3456. Also read the Guide to Dental Coverage.
How Can I Enroll In Apple Health
You can enroll in Apple Health at any point during the year on the Washington Healthplan Finder. If you do not qualify for Apple Health, the Washington Healthplan Finder has many other insurance options for you to choose from.
About 7-10 days after applying for Apple Health coverage, a ProviderOne services card will be mailed to you. This is a plastic ID card that looks like other health insurance ID cards. Take this card with you to your doctor and dentist appointments. Providers use this card to make sure your service is covered.
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Is All Dental Treatment Free When Pregnant
If you are pregnant or have had a baby in the past 12 months, you qualify. All you need is a Maternity Exemption Certificate signed by your doctor or midwife. This certificate entitles you to free prescriptions and NHS dental care. You can get the Maternity Exemption application form from your doctor or midwife.
Does Pregnancy Medicaid Cover Dental
Although pregnant women enrolled in Medicaid and CHIP are entitled to ?pregnancy-related services,? dental care is not explicitly included as a pregnancy-related service, and federal Medicaid law leaves dental care for adult enrollees as a state option.3 CHIP requires coverage of dental care for youth, including
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Does Private Insurance Also Cover A Newborn
It depends. Small group employer-sponsored plans must include the EHBs, including maternity and newborn care, but large group and self-insured employer-sponsored plans are exempt from this requirement. While the requirement for newborn care covers childbirth and immediate care following birth, women must enroll their babies in coverage soon after birth.
Who Is Eligible For Apple Health
People of all ages may be eligible for coverage under Apple Health, including yourself, your parents, and your children. The Washington State Health Care Authoritys website details all the ways you may be eligible for Apple Health. Click the link below that best describes you and/or your family to learn more.
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Do Marketplace Health Plans Provide Women With Comprehensive Coverage Including Maternity Care
Yes. All Marketplace plans must include the ten Essential Health Benefits , one of which is maternity and newborn care. HHS has not specified what must be covered under this category, delegating that authority to the states. Thus, specific benefits covered under maternity care vary by state.
2. What changes when a woman enrolled in a Marketplace plan becomes pregnant?
Nothing, unless she wants it to. The woman may choose to remain in a Marketplace plan or, if eligible, to enroll in Medicaid or CHIP. The woman will not lose eligibility for the APTCs as a result of access to MEC through full-scope or pregnancy-related Medicaid, but cannot be enrolled in both simultaneously and thus must choose. In deciding which coverage to select, overall cost, access to preferred providers, impact of transitioning across plans, and effect on family coverage influence preference.
Here Is A List Of What May Be Covered For Pregnant Women Under Medicaid
Fillings. To make sure that there will be no infections that can spread.
Teeth cleaning. To prevent gum disease.
Emergency wisdom tooth removal. This is not guaranteed, but can be covered if it can be
proven that it is medically necessary.
Root canal. To stop the spread of infection to other teeth.
The key to avoiding bad oral health during pregnancy would be to keep healthy habits. Brushing and flossing regularly, as well as eating the right food will ensure that teeth and gums stay healthy, even during pregnancy. Regular visits to the dentist would also be crucial. In a nutshell, if a pregnant woman has practiced good oral habits even before getting pregnant, it will be unlikely that she will experience oral problems at all.
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How Do I Find Low
To find dental clinics for low-income families or individuals:
- Contact your local health department
- Contact a local dental school
- Participate in a clinical study
- Contact a Health Insurance Navigator
And to find dentists and dental clinics that accept Medicaid:
- Consult the provider booklet that came with your insurance to find Medicaid dental offices
Virginias Medicaid Expands Now Covers Dental And Prenatal Services
NEW RIVER VALLEY, Va. – Virginias Medicaid has now expanded to include dental benefits and prenatal services.
Before the recent expansion, Virginias Medicaid dental benefits were only available for children and teens, but they now include adults.
Adults thats enrolled in Medicaid ages 19 to 64 would now be eligible for dental benefits, and that would include things like preventative care, dentures, fillings, cleanings and many more benefits— root canals included as well, said Amber Poron, a Navigator Outreach Coordinator for Virginia Poverty Law Center.
New and current enrollees will be able to access full dental services including X-Rays, exams, root canals, oral surgeries and more.
So its really very important because a lot of people have gone several years without getting the dental care thats needed, and your dental care can affect your overall health, said Poron.
Leaders from Virginias Poverty Law Center also say this decision to expand these services is historic and may result in thousands more Virginians enrolling in Medicaid.
The majority of people are interested in getting care for their teeth done, so I feel like this might be the deciding factor for some people that have not wanted to enroll in Medicaid. And now theyre able to get the dental benefits and maybe that will make it worth it for them, said Poron.
The prenatal benefits will also continue 60 days post-partum.
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Medicaid Dental Providers For Adults And Children
According to the American Dental Association, 36% of lower-income Americans have lived through untreated cavities. Dentists that take Medicaid can be hard to find, in fact, only 38% of dentists in the US accept Medicaid.
The low percentage of participation of Americans in Medicaid may be due to the facts that:
- Many states make it very difficult for providers to become dentists that accept Medicaid
- Those who can receive dental coverage from Medicaid in their state are unaware.
If you need to find a dentist that takes Medicaid, Medicare or CHIP, you can go to Dentaquest’s Find a Dentist page and search by state.
Another way to find a dentist that accepts Medicaid is simply by calling an office near you and asking.
Also, you’ll most likely receive a booklet along with your Medicaid insurance information. Inside should be listed all of the Medicaid dental providers in your area.
State Oral Health Action Plans
To support the Oral health Initiative, CMS invited state Medicaid agencies to develop State Oral Health Action Plans as a roadmap to achieving in their goals.
CMS has received SOHAPs from the following 25 states: Alabama , Alaska , Arizona , California, Connecticut, District of Columbia , Delaware , Florida , Maine, , Massachusetts , Michigan , Missouri , Nebraska, New Hampshire , New Jersey , North Dakota , Oklahoma , Pennsylvania , Tennessee , Utah , Vermont , Virginia , Washington and Wyoming . 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.
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. Completed SOHAPs may be submitted to Andrew Snyder, Health Insurance Specialist via email to with a copy to your CMS Regional Office contact. Any questions about the SOHAPs may also be directed to Mr. Snyder.
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Medicaid Benefits Many Women
Medicaid insurance is of benefit to many women in financial need during pregnancy. Even if you were not eligible before, you may become eligible once you are pregnant. At the least, all your pregnancy-related medical care will be covered and depending on which state you reside in, you may qualify for medical care not related to your pregnancy.
Is A Woman Who Has Access To A Family Members Employer
Possibly. If the employer-sponsored insurance is unaffordable or not MEC, the woman is eligible for APTCs. Affordability is determined by the IRS standards for the percentage of income a person is expected to spend on insurance. This calculation applies to the cost of the employees insurance, not the cost of the family plan. That means that if the premiums for the employees insurance are affordable, no member of the family is eligible for an APTC. If the individuals premium is unaffordable, the family will be eligible for APTCs in an amount determined by their income and the premium cost.
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How Much Does Apple Health Cost
Apple Health premiums are either free or low-cost depending on income level. Even if you are working, you and your family might still be eligible for Apple Health. The Health Care Authoritys website lets you know how much your premiums will be based on your eligibility.
What Does Medicaid Cover In Your State
To give you a better idea of how wide the range of services can be from state to state, heres a comparison of optional benefits for Medicaid coverage in four states:
Medicaid Coverage in Nevada
What does Medicaid cover in Nevada?
Nevada Medicaid provides quality health services to low-income Nevadans who qualify based on state and federal law. Nevada Medicaid does not reimburse an individual for medical services. Payments are sent directly to health care providers when they render services to Medicaid recipients.
Nevada Check Up is offered concurrently with Medicaid and is designed for children who do not qualify for Medicaid but who come from families with incomes that are at or below 200% of the Federal Poverty Level. Nevada Medicaid is the payer of last resort, meaning that if you have other health insurance that can pay a portion of your bills, then payment will be collected from them first. Benefits covered by Nevada Medicaid and Nevada Check Up include:
- Transportation Services
- Waiver Program Services
Medicaid Coverage in Texas
What does Medicaid cover in Texas?
Texas Health and Human Services administers Medicaid and CHIP in the state. It administers four Medicaid programs: STAR, STAR+PLUS, STAR Health and traditional Medicaid. The type of Medicaid coverage a person gets depends on where the person lives and what kind of health issues the person has.
These benefits include:
Medicaid Coverage in New York
What does Medicaid cover in New York?
Types Of Medicaid Plans Including Dental
The type of Medicaid that you have could impact whether it pays for dental work for adults. Each state offers a variety of plans designed for different groups of low-income individuals.
In addition to the straight or regular program, you could enroll in unique plans for pregnant women, dual-eligible Medicare recipients, and individuals deemed medically needy.
Dental Care For Children Ages 0
- Dental Exams
- Problem focused
- Pain management
Some Services may require permission from a dental plan before the dentist performs the service. This is called a prior authorization. Services must be medically necessary in order for dental plans to pay for them. For more details about dental services, contact the recipientâs dental plan starting December 1, 2018.
- Additional dental exams
- Dental consultations
- Dental office diabetic testing
- A visit to the dental office to get comfortable with the office and the dentist before dental work is done for persons with disabilities
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Adult Medicaid Including Medallion And Ccc+
Effective January 1, 2019 adults in Virginia with household incomes up to 138% of the federal poverty level are eligible for Medicaid. Medicaid covers dental extractions and related costs. HOWEVER, the Managed Care Organizations administering the program have added additional benefits such as comprehensive exams and cleanings. Some even offer money towards other dental care. If you wish to change Managed Care Organizations so you get different dental benefits, call the Managed Care Helpline at 1-800-643-2273 . The helpline is available Monday through Friday from 8:30 am to 6:00 pm.
If you are disabled and have both Medicaid and Medicare you also have additional benefits
Cover Virginia is your best source for information if you are new to Medicaid. Their website is
Is It Ok To Have Dental Work While Pregnant
Dental work while pregnant, such as cavity fillings and crowns, should be treated to reduce the chance of infection. If dental work is done during pregnancy, the second trimester is ideal. It is best to avoid this dental work while pregnant and avoid exposing the developing baby to any risks, even if they are minimal.
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Upcoming Changes To Dental Services In Florida Medicaid
In 2016, the Florida Legislature directed the Agency for Health Care Administration to enroll most Medicaid recipients into dental plans. Recipients will receive a dental plan based on the below schedule. The schedule is separated into phases by the recipients county location.
Recipients will begin to receive letters soon. They will be mailed out about 45 days before each phase starts. For example, recipients will begin to receive letters for Phase 1 in the middle of October. For more information, please click on the following link:
What Does Medicaid Cover
Medicaid is a social insurance program administered by state and federal governments designed to cover the basic healthcare needs of lower income families in America. This means that Medicaid helps people with low incomes cover their health care costs. But what does Medicaid cover for you? And are you eligible for Medicaid in your state?
To qualify for Medicaid coverage, a person must make less than 133 percent of the federal poverty line, which is about $16,000 for an individual or about $32,000 for a family of four.
In recent years, Medicaid enrollment has surged across the U.S. and now, along with the companion Childrens Health Insurance Program program, cover more than 74 million people.
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Medicaid Dental Coverage By State
|States that provide extensive Medicaid dental coverage||States that provide limited Medicaid dental coverage||States that only cover emergency Medicaid dental services||States that don’t provide any Medicaid dental coverage||States who expanded Medicaid under the Affordable Care Act|
|Alaska, California, Connecticut, Iowa, Massachusetts, Montana, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Rhode Island, Washington, Wisconsin||Arkansas, Colorado, Ilinois, Indiana, Kansas, Kentucky, Lousiana, Michigan, Minnesota, Montana, Nebraska, Pennsylvannia, South Carolina, South Dakota, Vermont, Virginia, Wyoming||Arizona, Florida, Georgia, Hawaii, Idaho, Maine, Maryland, Mississippi, Nevada, New Hampshire, Oklahoma, Texas, Utah, West Virginia||Alabama, Delaware, Tenessee||Arizona, Hawaii, Maryland, Nevada, Hew Hampshire, West Virginia, Arkansas, Colorado, Illinois, Indiana, Kentucky, Louisiana, Michigan, Minnesota, Pennsylvania, Vermont, Alaska, California, Connecticut, Iowa, Massachussets, Montana, New Jersey, New Mexico, New York, Ohio, Orgegon, Rhode Island, Washington|
As you can see from this table that shows Medicaid dental coverage by state, different benefits are given to those in the Medicaid base population and Medicaid expansion population.
People who fall into the Medicaid base population are those who were receiving Medicaid before the Medicaid Expansion Program under the Affordable Care Act.