ADEA State Update

Iowa Dental Benefits Under Medicaid Set to Change on July 1

(State Policy, Insurance, Medicare and Medicaid, Medicare and Medicaid Services, Dental Health, Oral Health) Permanent link   All Posts

DentalWellnessPlanBeginning July 1, most adult Medicaid members, age 19 and older, in Iowa will be enrolled in the new Dental Wellness Plan

Under the current Medicaid program, those insured in the Dental Wellness Program have access to core services, including exams and cleaning as well as emergency services. But the plan incentivizes more complex work, such as root canals and denture repairs. Those on the plan can earn these services by completing a recall exam within six to 12 months of their initial exam.

However, on July 1, all Medicaid enrollees will have access to dental benefits for the first year under the new Dental Wellness Plan. Medicaid enrollees will be asked to complete ‘Healthy Behaviors’ which consists of completing both a dental self-assessment and preventive service. If they complete those healthy behaviors, benefits will continue in the second year without a copay. However, if they do not, enrollees will be responsible for paying a monthly premium of no more than $3 per month.

Enrollees will be able to declare a hardship and not pay that premium, however, if they do not complete the healthy behaviors, pay the premium or mark a hardship, benefits will be more limited, consisting of only emergency dental benefits.

Duggan Dental