Dental coverage to be added to Medicaid in Delaware

NEW CASTLE — Adult Delawareans who receive Medicaid will automatically get dental coverage as part of their plan starting Thursday, according to the Delaware Department of Health and Social Services.

Gov. John Carney signed legislation establishing the Medicaid adult dental benefit in August 2019. Implementation was originally scheduled for April 2020 but was delayed by the coronavirus pandemic.

Beginning Thursday, individuals ages 19-65 who are enrolled in a managed-care Medicaid plan 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 (adults and children) in Delaware are served by one of two managed-care organizations, Highmark Health Options Blue Cross Blue Shield Delaware and AmeriHealth Caritas Delaware.

Adults who are enrolled in fee-for-service Medicaid will receive their adult dental services through that program and may obtain a list of providers from the 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, including exams, cleanings, fillings, sedation 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 Friday, Gov. Carney suspended the $3-per-visit co-pay for adult dental treatments during the COVID-19 public health emergency. Adult Medicaid patients will not be charged the co-pay while the state of emergency remains in effect, and dental providers will not 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 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 provide no-cost or low-cost health coverage for eligible children.

Molly Magarik

“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.”

According to Steve Groff, director of DHSS’ Division of Medicaid and Medical Assistance, “It has been our long-standing priority to offer preventive and restorative dental treatment for adults, to address negative health outcomes associated with the lack of oral health care.

“With this benefit, adults on Medicaid will have access to affordable dental coverage.”

DHSS said 125 dentists have signed up to participate in the adult Medicaid program — 87 in New Castle County, 18 in Kent County and 20 in Sussex County.

More information about the Medicaid adult dental benefit is available on the division’s website or by calling (866) 843-7212.

In addition to the start of the dental benefit for adults, October also marks the annual open-enrollment period for Medicaid in Delaware, during which individuals can make changes to their managed-care plan. Open enrollment runs all month. Call (800) 996-9969 for more information.