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Implementation

The Medicaid adult dental waiver program began on June 1, 2019.  The statewide pilot program will serve the approximately 38,510 individuals between the ages of 21 and 64 who are dually eligible for both Medicare and Medicaid. 

Adult Dental Waiver Program approved

The Center for Medicare and Medicaid Services (CMS) approved the Maryland Department of Health’s (MDH) amendment to the Maryland HealthChoice §1115 demonstration waiver, which established a Medicaid adult dental benefit for dual-eligible adults ages 21-64. The new program, which went into effect on June 1, 2019, is the result of the efforts of MDAC and its coalition partners to ensure the passage of SB 284.

In a March 18, 2019 letter to MDH Chief Operating Officer and Medicaid Director Dennis Schrader granting approval for the program, CMS noted that “This pilot is likely to improve health outcomes, since improving oral health can impact overall physical health."  The statewide waiver program will provide access to diagnostic, preventive and basic restorative dental services, as well as extractions, to nearly 40,000 adults dually eligible for Medicaid and Medicare (e.g. low income and with a qualifying disability), up to an annual cap of $800.00. Click here for a detail of services and reimbursement rates.

Work to ensure program success

The Maryland Department of Health has reached out to dentists currently enrolled in Healthy Smiles,Maryland Medicaid’s children’s dental program, to identify providers who can accept these newly-covered individuals into their practices. Medicaid and MDAC are working together to recruit additional providers not currently enrolled in Healthy Smiles to see these new patients.

To ensure the success of this program, MDAC launched a Medicaid adult dental collaborative, a group of oral health stakeholders statewide working together to ensure the success of this new program.  MDAC’s collaborative will support Medicaid’s efforts, scrutinize processes and, if necessary, make recommendations or mid-course corrections to ensure the program’s success. Collaborative members include clinicians, social service agencies, dual-eligible individuals, and caregivers, among others.

The collaborative will focus on two primary goals:

  • Ensure access to services through robust dental professional participation
  • Ensure client utilization of dental services through outreach about the benefit

MDAC has provided information to dental professionals about the program and how to enroll as a provider. MDAC also hosted a continuing education class, led by Dr. Harvey Levy, on treating patients with anxiety and special needs.

 

 

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