The Alaska Department of Health and Social Services is reinstating Alaska’s adult preventive dental program (also known as the Adult Enhanced Dental Program) for Medicaid recipients effective Dec. 31, 2019.
Program services will also be retroactively covered to Oct. 1, 2019, when the program was discontinued as part of an overall effort to address the state’s budget deficit.
The decision to reinstate the program was made by DHSS Commissioner Adam Crum in coordination with the governor’s office, and was based on extensive consultation between DHSS program staff and the Centers for Medicare and Medicaid Services (CMS).
Funding for the program – $8.3 million of state general funds with a federal match of $18.7 million – is included in the governor’s FY2021 budget that was released Wednesday.
Adult enhanced dental services include preventive and restorative dental care such as cleanings, fillings and restorative work.
These services were originally scheduled to be discontinued July 1, 2019, but were temporarily extended through Sept. 30, 2019, to allow adequate time for recipients to receive notice of this Medicaid change and adequately plan their preventive dental care.
After the program ended on Oct. 1, 2019, dental services continued to be available to Medicaid recipients in Alaska through Medicaid’s emergency dental program.
As DHSS worked with CMS to discontinue this program, the federal agency advised staff that while the program is optional for states and more than half of states do not provide the program, most of the dental services included in the program were obligated to continue under federal law according to the essential benefits plan of the Affordable Care Act. Also under federal law, preventive dental care services must be covered by Medicaid when provided at federally qualified health centers that offer preventative dental care. These centers provide services to underserved populations to ensure health equity.
“After many months of discussions and a full review of all of the options, DHSS determined the best way to meet our obligation to Medicaid recipients and to maintain the fiscal integrity of the program was to reinstate the Adult Enhanced Dental Program,” said Commissioner Crum. “Initially we thought eliminating the program would be best but, because of the program’s complex rules and federal requirements, this was the more prudent option to benefit the health and well-being of Alaskans and our state’s fiscal sustainability.”
Southcentral Foundation President and Chief Executive Officer Katherine Gottlieb said, “This reinstatement of adult dental services to the budget ensures the importance of preventative care in maintaining health, avoiding unnecessary pain and saving many dollars in the long term.”
DHSS will be reviewing all denied claims and prior authorizations from Oct. 1 until now and will provide benefits to recipients according to the original Adult Enhanced Dental Program. The same annual limit of $1,150 for services that was part of the original program will continue to apply.
Health care providers will receive notice of this change through a remittance advice message from Medicaid next week. This is the standard form of communication between the program and providers. Medicaid recipients will receive letters next week notifying them the dental program will be restored.