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01/02/2016 09:53:21

DPHHS propose Medicaid rules to eliminate dental services

Rules to implement Medicaid budget cuts adopted by Gov. Bullock and the 2017 Special Session of the Legislature were proposed January 12 by the Department of Public Health and Human Services. The rules are will become effective March 1, 2018.

Proposed changes will eliminate coverage for dentures, crowns and bridges for adults.

Comprehensive orthodontic treatment will be limited to children 20 years or younger. Children may qualify for treatment only if they have cleft palate, deep impinging overbite, interior impaction or a score of 30 or higher on the Handicapping Labial-Lingual Form (HLD Index).

You can download the complete rule proposal at this link. Medicaid Rate, Service, and Benefit Changes . See below for page references to dental services in this document.

A public hearing will be held on February 1 at 1 PM at the DPHHS building, 111 N. Sanders in Helena. Comments on the rules may be submitted by February 9, 2018 to DPHHS Legal Affairs at PO Box 4210, Helena, MT 59604-4210 or emailed to dphhslegal [AT] mt [DOT] gov or faxed to (406) 444-9744.

MDA representatives will testify at the February 1 hearing. Your comments will be helpful to build MDA’s testimony. Please email to Dave Hemion, MDA Executive Director, at dave [AT] montanadental [DOT] org or call (800) 257-4988.

Medicaid rule proposal page references for dental:

Page 67: February 1 hearing information.

Page 69: Changes effective date For Relative Values for Dentists from January 1, 2018 to March 1, 2018

Pages 71-72: Specifies services to be eliminated for adults and changes to orthodontia.

Pages 78-79: DPHHS Summary Statement of Reasonable Necessity.

Pages 80 and 82: DPHHS Statement of Reasonable Necessity for reductions in dental services.

Pages 85-86: Financial impacts on dentists and denturists. Total budget reduction in Medicaid dental service for fiscal years 2018 and 2019 is $8,928,242.

Page 88: Where to submit comments on the proposed rule.

The Governor and Legislature also cut Medicaid reimbursement rates for dentists and other providers by 2.99%, effective January 1, 2018.

IMPORTANT UPDATE : Dental Medicaid budget cut effective date

The Department of Public Health and Human Services informed MDA today that dental services covered by Medicaid for adults and for children are unchanged until further notice by DPHHS.

The reduction in dental services included in the budget cuts made by Gov. Bullock and approved by the Legislature will not go into effect until DPHHS implements amended rules early in 2018. The rulemaking process will include opportunities for comment. DPHHS said it will notify dentists regarding the reduced schedule of covered Medicaid dental services.

Please note that services for children - except orthodontia - are not affected by the budget cuts. Eligibility for children’s orthodontia is proposed to be restricted to those meeting a Handicapping Labio-Lingual Deviation score of 30 or greater.

MDA will provide further updates by email and will post to Please contact the MDA office (800) 257-4988 for further information.

Dave Hemion, Executive Director

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