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Medicaid Adult Dental Benefit


Update 10/12/2020

Several updates have been made to the Adult Dental Fee Schedule. These updates include coverage of D1206 (Topical Application of Fluoride Varnish) and D1208 (Topical Application of Fluoride-Excluding Fluoride Varnish). A provider may bill one or the other of these fluoride codes 1x every 12 months. Additionally, clarification was made to the note on D0120.

Senate Substitute 1 for Senate Bill 92, enacted in 2019, directs the Division of Medicaid and Medical Assistance (DMMA) to establish an adult dental benefit. Adult dental coverage is optional for state Medicaid programs, but most offer at least an emergency dental benefit. 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. The benefit will enable Medicaid-enrolled adults to receive up to $1,000 of dental care per year. An additional $1,500 may be available for qualifying emergency or supplemental care when medically necessary.

Unfortunately, we will be unable to meet the April 1, 2020, implementation date included in the legislation. We are working closely with the Centers for Medicare and Medicaid Services, but estimate an additional six months will be needed to receive all the necessary federal approvals and complete the subsequent administrative tasks necessary to begin the program. The projected implementation date is now October 1, 2020. The full benefit will be available upon the implementation of the program.

We apologize for the inconvenience this will cause to our beneficiaries who are waiting for these critically needed services and assure you that we will continue to move forward as quickly and expeditiously as possible.

We want to express our appreciation for the continued support and collaboration of Governor Carney, Lt. Governor Hall-Long, members of the General Assembly, the Dental Society, and other stakeholders.

If you have questions you can reach us by emailing: MedicaidInfo@delaware.gov

Medicaid Adult Dental Services

Correction Posted 10/06/2020

An announcement posted on the State of Delaware/DHSS website announcing Medicaid's new adult benefit contained incorrect information regarding the age group for adult dental benefits.

This announcement indicated that beginning October 1, 2020 individual's age 19-65 who are enrolled in managed care would receive their adult dental services through their managed care organization. This information is incorrect.

The adult dental benefit begins at age 21 not 19 as described in this announcement. Adults age 19-20 will continue to receive their dental benefits through the FFS program.

There is no age limit on who can receive adult dental services. Adults over the age of 65 may receive adult dental services.

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