Michigan Increases Reimbursement and Expands Medicaid Dental Benefits

As part of efforts to improve access to oral healthcare, the Michigan Department of Health and Human Services has expanded dental benefits for adult Medicaid beneficiaries and increased rates for dental providers. This redesigned benefit, which took effect April 1, is expected to increase access to services, enhance care coordination, and improve health outcomes.

An $85.1 million investment in increased reimbursement and $30 million in redesigned benefits will now cover a range of services for beneficiaries age 21 and older. Under the new program, insured services include radiographs, prophylaxes, scaling and root planing, restorative treatment (including direct restorations, crowns, and dentures), root canal therapy, sealants and extractions.

As a first step in the redesign, a policy that substantially increased reimbursement for Medicaid dental services was implemented in January. In order to incentivize providers to accept Medicaid patients, clinicians are now being paid at 100% of the average commercial rate for care rendered under the program. Noting the “unsustainable” nature of the previous low reimbursement fees, Vincent V. Benivegna, DDS, president of the Michigan Dental Association, says the new rates “recognize the value of quality care and will allow more dental providers to treat Medicaid patients.”

With federal legislation reintroduced this year in the House and Senate to establish a federally mandated adult Medicaid dental benefit, stakeholders from across the country will be watching to see if Michigan’s expanded coverage and new fee structure will result in increased access to, and utilization of, oral healthcare services.