CHIP and Children's Medicaid Dental Services
Main dentist requirement temporarily suspended: HHSC transitioned all Delta Dental Medicaid and CHIP members to MCNA Dental and DentaQuest for coverage starting December 1, 2012. However, some patients may have been assigned to an incorrect main dentist. To avoid delays in care, HHSC is temporarily suspending the requirement that a patient must be served by their main dentist. This suspension is effective immediately and will continue through February 28, 2013. Patients were mailed a letter in late November with their new dental plan information and can contact their new dental plan to verify their preferred dental provider.
Transition of Delta Dental Members: The Texas Health and Human Services Commission (HHSC) announced in September that HHSC and Delta Dental have agreed to end Delta Dental’s contract to provide children’s Medicaid and Children’s Health Insurance Program (CHIP) dental services on November 30, 2012. Beginning December 1, 2012, members will receive services through DentaQuest or MCNA Dental.
HHSC will work to help members maintain their main dentist. Delta Dental members will be enrolled into a dental plan contracted with the member’s main dentist when possible. Members whose main dentist is not contracted with DentaQuest or MCNA Dental will be evenly distributed to the other plans. In late November, HHSC will send a letter to Delta Dental members to notify them of their new dental plan.
Parents with children enrolled in Medicaid dental services who want to change their children’s dental plan may call the enrollment helpline at 1-800-964-2777.
Parents with children enrolled in CHIP dental services who want to change their children’s dental plan may call the CHIP helpline at 1-877-543-7669. Parents have 90 days from December 1, 2012, to change their CHIP dental plan.
Current Delta Dental Medicaid and CHIP providers who are not under contract with DentaQuest or MCNA, and who would like to provide services to Medicaid and CHIP clients, may contact provider services at the numbers listed below.
- DentaQuest: 1-800-896-2374
- MCNA: 1-855-776-6262
Dental Plans May Review Necessity of Orthodontic Services: Managed care dental plans may conduct medical necessity reviews on orthodontia cases that were authorized before March 1, 2012. Dental providers providing orthodontia services to patients that have been determined by the dental plan to not meet medically necessary criteria are responsible for the patient’s continuation of care. Orthodontia providers cannot require Medicaid patients to pay out-of-pocket to continue non-medically necessary treatment or to have their braces removed. All orthodontic providers must comply with the rules and regulations of the Texas State Board of Dental Examiners, including those providers who discontinue contracts with the Texas Medicaid program. Providers who do not comply with licensure rules and regulations will be referred to the Texas Office of Inspector General and the dental board.
Right now, children enrolled in the Children’s Health Insurance Program (CHIP) get managed care dental services through a dental plan. Beginning March 1, 2012, most children and young adults age 20 and younger enrolled in Medicaid also will start getting dental services through a dental plan. There will be three dental plans to choose from.
Some people will continue to get dental services the same way they do now:
- People with Medicaid age 21 and older
- All Medicaid clients, regardless of age, who live in Medicaid-paid facilities such as nursing homes, state supported living centers, or Intermediate Care Facilities for Mentally Retarded Persons (ICFs/MR)
- Children and young adults in the state’s foster care program who are enrolled in STAR Health
Client Resource Materials
- Children’s Medicaid Dental Services Enrollment Packet
- Children’s Medicaid Dental Services Welcome Letter
- Common Questions: Medicaid Dental Services for Children