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Several updates have been made to the Adult Dental Fee Schedule. These updates include coverage of D1206 (Topical Application of Fluoride Varnish) and D1208 (Topical Application of Fluoride-Excluding Fluoride Varnish). A provider may bill one or the other of these fluoride codes 1x every 12 months. Additionally, clarification was made to the note on D0120.
Senate Substitute 1 for Senate Bill 92, enacted in 2019, directs the Division of Medicaid and Medical Assistance (DMMA) to establish an adult dental benefit. Adult dental coverage is optional for state Medicaid programs, but most offer at least an emergency dental benefit. It has been a long-standing priority of DMMA to offer preventive and restorative dental treatment for our adult population to address negative health outcomes associated with the lack of oral health care. The benefit will enable Medicaid-enrolled adults to receive up to $1,000 of dental care per year. An additional $1,500 may be available for qualifying emergency or supplemental care when medically necessary.
Unfortunately, we will be unable to meet the April 1, 2020, implementation date included in the legislation. We are working closely with the Centers for Medicare and Medicaid Services, but estimate an additional six months will be needed to receive all the necessary federal approvals and complete the subsequent administrative tasks necessary to begin the program. The projected implementation date is now October 1, 2020. The full benefit will be available upon the implementation of the program.
We apologize for the inconvenience this will cause to our beneficiaries who are waiting for these critically needed services and assure you that we will continue to move forward as quickly and expeditiously as possible.
We want to express our appreciation for the continued support and collaboration of Governor Carney, Lt. Governor Hall-Long, members of the General Assembly, the Dental Society, and other stakeholders.
If you have questions you can reach us by emailing: MedicaidInfo@delaware.gov
An announcement posted on the State of Delaware/DHSS website announcing Medicaid's new adult benefit contained incorrect information regarding the age group for adult dental benefits.
This announcement indicated that beginning October 1, 2020 individual's age 19-65 who are enrolled in managed care would receive their adult dental services through their managed care organization. This information is incorrect.
The adult dental benefit begins at age 21 not 19 as described in this announcement. Adults age 19-20 will continue to receive their dental benefits through the FFS program.
There is no age limit on who can receive adult dental services. Adults over the age of 65 may receive adult dental services.
Medicaid furnishes medical assistance to eligible low-income families and to eligible aged, blind and/or disabled people whose income is insufficient to meet the cost of necessary medical services. Apply for Medicaid | Learn about Medicaid
Delaware Prescription Assistance Program has been reinstated as of January 1, 2019 and is currently accepting applications.
Customer Relations provides general information, referrals and assistance to DMMA and Division of Social Services applicants, clients, staff and others inquiring about Medicaid benefits and services. (302) 571-4900 or (866) 843-7212.
Provider Relations helps Delaware Medical Assistance Program (DMAP) Providers enroll in the Medicaid program, receive and respond to provider inquiries, verify client eligibility and aid in submitting electronic claims. (800) 999-3371.
The Delaware Aging and Disability Resource Center can help eligible individuals find dental care and many other services. If you need a dentist for a child, use this Dentist Locator to find a dentist near you who sees children and accepts Medicaid and CHIP.
Administrative Notices are used to provide updates and instruction to operational staff on Medicaid policy.
Find monthly enrollment totals for Medicaid and CHIP plus other reports and information.
The Medicaid Health Benefits Manager helps you enroll in a Managed Care Organization (MCO) and understand your benefits and prescriptions. (800) 996-9969.
Delaware's Medicaid state plan is an agreement between the state and the federal government that describes how Delaware administers its Medicaid program. The plan gives an assurance that the state will abide by federal rules and may claim federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities underway in the state.
Customer Relations: (866) 843-7212
Provider Relations: (800) 999-3371
Health Benefits Manager: (800) 996-9969