Recent Medicaid dental policy changes in Michigan


James Sklar


Following suit with multiple other states in recent months, Michigan has recently implemented significant reforms to its Medicaid coverage of dental services.


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The Michigan Department of Health and Human Services (MDHHS) released their final proposed policy in December to increase Medicaid payment rates for dental services provided in ambulatory surgical centers and outpatient hospitals. 

MDHHS implemented the rate increase on October 1st, 2022, and it received CMS approval in November. Ambulatory surgical centers’ dental surgery procedure minimum rate increased from $82.16 to $1,495 and outpatient hospitals’ minimum rate increased from $126.40 to $2,300.

Looking to further reform the state’s approach to paying for dental visits under Medicaid,  MDHHS also proposed a new dental reimbursement methodology last month for the 2023 calendar year. Though the proposal still needs CMS approval, MDHHS implemented the new rule change on January 1st, and is collecting public comment on the new methodology up to January 5th. 

Under the updated methodology, Medicaid dental fee screens are set at the average commercial rate. MDHHS staff will determine the average commercial rate through information supplied by commercial dental insurers.

If rate information is not available, MDHHS will determine the rates based on other state Medicaid programs, provider charges, and other sources. Concurrently, MDHHS is implementing the new rule change while receiving public comments. Public comments will be collected via email and are due before January 5th, 2023.

Lastly, effective January 1st, 2023, MDHHS will expand dental sealant coverage for beneficiaries under age 21 for the prevention of pit and fissure caries.

The American Academy of Pediatric Dentistry (AAPD) recommends dental sealant coverage for certain molars and permanent premolars for any beneficiary under age 21 to prevent and reduce the likelihood of tooth decay. This expanded coverage aligns with the AAPD recommendations for pediatric oral health assessment, preventive services, and anticipatory guidance/counseling schedule. 

The new policy will cover sealants once every three years, which includes repair and replacement.