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Benefit cap set for Iowa Medicaid dental plans

Benefit cap set for Iowa Medicaid dental plans

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Dental benefits for Medicaid members will be capped starting July 1, state officials announced.

Iowa Medicaid Enterprises will be accepting public comment through the end of June.

This week, the state program announced a benefit limit for adult members enrolled in the Dental Wellness Plan, a plan that allows adult Medicaid members aged 19 and older to receive dental coverage from carriers Delta Dental and MCNA Dental.

“The Iowa Department of Human Services is making these changes to ensure the (Dental Wellness Plan) is sustainable long term,” stated the announcement, which was sent in an Iowa Medicaid email newsletter.

The new rule — in place for members aged 21 and older, or a total of 301,348 members in Iowa — will put in place a benefit maximum of $1,000 of services per member per fiscal year, which runs July 1, 2018 to June 30, 2019.

Children will not be affected by this change.

The dental benefits themselves are not changing, said Matt Highland, spokesman for the Department of Human Services, in an email to The Gazette.

This limit does not include preventive, diagnostic or emergency dental services, as well as anesthesia in conjunction with oral surgery and fabrication of dentures. According to the DHS announcement, the cap will be on services such as annual checkups, cleanings, X-rays and fluoride treatments.

Members will be limited to one set of replacement dentures every five years. But a replacement sooner than that is possible by obtaining prior authorization for a medically necessary replacement.

“There already is a $1,000 yearly maximum for dental benefits under the Hawk-i program,” Highland said. Having this cap “will bring the (Dental Wellness Plan) more in line with commercial dental plans and the state’s dental insurance plan, which has a $1,500 yearly benefit max.”

DHS is accepting public comments on the new annual benefit limit for Dental Wellness Plan members through June 29 at 4:30 p.m.


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