Michigan continues to expand Medicaid dental coverage


James Sklar


Over the past few months, Michigan’s Department of Health and Human Services (MDHHS) has implemented a variety of changes to its Medicaid dental policy. On April 1st, MDHHS continued its expansion of covered dental services by adding deep teeth cleanings, sealants, root canals, crowns, and care to keep gums healthy as Medicaid benefits.

This comes after the department increased provider reimbursement rates to the average commercial rate, expanded dental sealant coverage for individuals under 21, and implemented a new reimbursement methodology for dental services on Jan. 1st. In October, MDHHS submitted a redesign proposal to the legislature, then began the implementation process in December after the legislature approved the redesign. 

These numerous changes stem from stakeholder input, Healthy Michigan Plan and Pregnant Women dental programs, and a November 2022 MDHHS report noting that there are access disparities in Michigan dental care. However, Vincent Benivegna, president of the Michigan Dental Association (MDA), told State of Reform that this has been in the works for a number of years.

He said this endeavor started about a year-and-a-half ago when he testified in front of Michigan’s House and Senate Appropriations Committees. He asked the legislature to allocate funds to support adult Medicaid and hospital issues.

Benivegna asked for more funds to help Medicaid patients because it became increasingly more difficult to get them into hospitals and dental offices, as the facilities would lose money based on Michigan’s Medicaid reimbursement rates.

“The hospitals were only getting $200 per patient per facility reimbursement fee, and the same amount for anesthesia,” Benivegna said. “Hospitals were telling us that it [normally] costs $2000 per patient for a facility fee and the anesthesiologist would say the same thing. So, [the hospitals] would tell us they were losing money by taking our patients.” 

Benivegna said these Medicaid dental reimbursement rates have not increased in roughly 30 years. 

“Dentists were losing money seeing Medicaid patients,” Benivegna said. “That’s why very few dentists in Michigan took Medicaid. They just couldn’t afford it. They could take a small portion, but they couldn’t make it a big part or substantial part of their practice.”

MDHHS reports it will invest $85.1 million to increase reimbursement rates and $30 million in redesigned benefits so recipients will not lose services. The department says funding was appropriated in the FY23 budget and represents a blend of federal Medicaid dollars and the state match necessary to secure those funds (around 65% in federal funding and 35% in state general funding). 

Approximately two million adults on Medicaid in Michigan could benefit from this change, MDHHS said. The number of Medicaid dental patients is also expected to be reduced over the next year as Medicaid redeterminations occur. 

“This positive change recognizes the strong correlation between oral and physical health outcomes,” said Elizabeth Hertel, MDHHS director, in a statement. “With better services and closer care coordination, we can maximize opportunities to create healthy outcomes for beneficiaries of all ages while also expanding the number of providers so Michigan’s residents can get care where and when they need it.”

MDHHS predicts that the change will be beneficial, as they received positive feedback from their recent provision of technical assistance to providers who were interested in becoming Medicaid providers. 

“I’m super happy this is happening,” Benivegna said. “It’s a huge benefit for the oral health of Michigan residents. Twenty-five percent are on Medicaid, and this is a huge number of residents this [policy] is going to affect. Anything that betters the oral health of our population is great.”

MDHHS said they are working with MDA, Michigan Oral Health Coalition, and Medicaid health plans to ensure broad awareness of these changes. Benivegna said he is making sure his organization is playing its part.

“We are putting together a web seminar right now to update our members on medical changes,” Benivegna said. “We are going to have a booth at our annual session this year in Grand Rapids, which is the first week in May, and we will be able to help people sign up for it. This is going to be published in our journal, in our e-news, and in all our communications. Plus as president, I do component visits, and I give talks and updates, and one of the things I inform people about are Medicaid updates.”