MDHHS implements additional changes to Medicaid dental policy


James Sklar


Michigan has been making changes to its Medicaid dental policies, having recently increased Medicaid payment rates for dental services provided in ambulatory surgical centers and outpatient hospitals and expanding dental sealant coverage for beneficiaries under age 21 for the prevention of pit and fissure caries. 


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At the end of January, the Michigan Department of Health and Human Services (MDHHS) proposed more changes to dental coverage, which come from a November 2022 MDHHS report noting that there are  access disparities in Michigan dental care.

“There are wide disparities in access to dental care and services among Michigan Medicaid enrollees,” read the report. “Fragmentation of benefit administration across the system and stagnant fee‐for‐service reimbursement rates have played a significant role in utilization and access variation.”

This new policy change would go into effect on April 1st, contingent on approval from CMS.

The proposed changes focus on the service delivery model, dental benefits, the provider verification process, prior authorization (PA) requirements, and Federally Qualified Health Centers (FQHC) and Tribal Health Centers (THC). 

The new proposed policy would implement a new service delivery model for adult beneficiaries who are enrolled in the various Michigan Medicaid plans. Approximately 430,000 people will be affected by the service delivery model changes, sources told. 

“The ‘Changes to Dental Benefits’ outlined in the policy will affect all adults enrolled in Medicaid or our expanded Medicaid Health Michigan Plan (approximately 1.9 million people),” said Bob Wheaton, public information officer for MDHHS. 

“One caveat is that these numbers will be reduced over the next year as the department undertakes the required redeterminations coming out of the continuous enrollment period during the pandemic that is being ended by the federal government. As a comparison point, in fiscal year 2019 we would have had 400,000 people affected by the service delivery model changes (rather than the 430,000 we have today).“

Providers would also have to verify if the beneficiaries are eligible for crowns or dentures. For services that require PA, requests would need to be submitted electronically. FQHCs would be reimbursed according to the prospective payment system or dental alternative payment methodology, and THCs will be reimbursed according to the all-inclusive rate methodology.

The new dental benefit changes would affect providers and beneficiaries who utilize topical application of fluoride, sealants, crowns, root canal therapy, periodontal treatment, and dentures.

Under current state Medicaid policy, preventive services including fluoride applications are only covered for beneficiaries ages 16 and under once every six months, which does not include coverage of polishing compounds, fluoride rinses, or self or home fluoride application procedures. The proposed policy change would only cover fluoride application for beneficiaries up to the age of 21 once every six months, and the change would still not cover polishing compounds, fluoride rinses, or self or home fluoride application procedures.

The new policy change would allow all beneficiaries to be covered for sealants rather than just beneficiaries ages five through 15. Similarly, crowns and root canal therapy would also be covered for all beneficiaries instead of just beneficiaries under 21. Periodontal services are covered for all beneficiaries under the proposed policy. It also removes the requirement that a beneficiary must have at least one anterior tooth or eight posterior teeth missing in order to receive denture coverage.