Adults in Delaware who receive Medicaid will automatically get dental coverage as part of their plan, effective October 1.
Governor John Carney signed legislation establishing the Medicaid adult dental benefit in August 2019. Implementation was originally scheduled for April 2020 but delated due to the pandemic.
Individuals between the ages of 19 and 65 who are enrolled in a managed care Medicaid plan now will receive their adult dental services through that plan and can obtain a list of providers from their managed care organization.
About 200,000 of the 235,000 Medicaid clients including adults and children in Delaware are served by two managed care organizations, Highmark Health Options Blue Cross Blue Shield Delaware and AmeriHealth Caritas Delaware.
Adults enrolled in fee-for-service (FFD) Medicaid will receive their adult dental services through that program and may obtain a list of providers from the Department of Health and Social Services (DHSS) Division of Medicaid and Medical Assistance by contacting the Delaware Health Benefits Manager at (800) 996-9969.
The benefit will cover a wide variety of services, the state said, including exams, cleanings, fillings, sedations, and regular tooth extractions. It will cover $1,000 of dental care per year. An additional $1,500 per year may be available for qualifying emergency or supplemental care when medically necessary.
In an emergency order issued September 25, Carney suspended the $3 per visit copay for adult dental treatments during the COVID-19 public health emergency. Adult Medicaid patients won’t be charged the copay while the state of emergency remains in effect. Also, dental providers won’t have their payments reduced by $3 but will be paid the full allowable amount by the Division of Medicaid and Medical Assistance.
Individuals who receive services through the Division of Developmental Disabilities Services (DDDS) may be eligible for additional dental coverage once they exhaust their Medicaid benefit.
Adult dental coverage is optional for state Medicaid programs, but most offer at least an emergency dental benefit. In Delaware, Medicaid and the Children’s Health Insurance Program (CHIP) provide no-cost or low-cost health coverage for eligible children.
“We know that low-income adults suffer disproportionately from dental disease and that poor oral health can increase risks for people with conditions like diabetes and heart disease,” said DHSS secretary Molly Magarik. “This new benefit will go a long way toward improving the overall health of Medicaid recipients in Delaware.”
“It has been our longstanding priority to offer preventive and restorative dental treatment for adults to address negative health outcomes associated with the lack of oral healthcare,” said Steve Groff, director of the DHSS Division of Medicaid and Medical Assistance. “With this benefit, adults on Medicaid will have access to affordable dental coverage.”
According to the state, 125 dentists have signed up to participate in the adult Medicaid program, with 87 in New Castle County, 18 in Kent County, and 20 in Sussex County. Further information is available online or by calling (866) 843-7212.