DOH Announces Medicaid Dental Benefit Changes
The Department of Health (DOH) has announced that effective Jan. 31, 2024, dental crowns and root canals will be included in the Managed Long Term Care (MLTC) and mainstream Medicaid managed care plan benefit packages. In addition, replacement dentures and implants will require only a recommendation from a dentist to determine medical necessity.
The new policy is incorporated into and supported by the following policy documents:
- 2023 Dental Benefit Criteria Guidance;
- NYS Medicaid Program Dental Policy and Procedure Code Manual;
- Justification of Need for Replacement Prosthesis form; and
- Evaluation of the Dental Implant Patient form.
MLTC and mainstream plans may choose to use their own forms for prior authorization purposes, but must submit the forms here no later than Jan. 2, 2024 for approval.
In addition, plans are required to update their member handbooks and provide a 30-day member notification for these dental services. The Department has made available template notices and member handbook inserts for reference purposes. MLTC and mainstream plans are to submit their proposed handbook language and member notice to the Department for approval no later than Nov. 27, 2023. MLTC and mainstream plans are also directed to mail approved member notices to enrollees by Dec. 31, 2023.
Contact: Karen Lipson, firstname.lastname@example.org