AHCA Logo

Upcoming Changes to Dental Services in Florida Medicaid

In 2016, the Florida Legislature directed the Agency for Health Care Administration (Agency) to enroll most Medicaid recipients into dental plans.
Recipients will receive a dental plan based on the below schedule. The schedule is separated into phases by the recipient’s county location.

Recipients will begin to receive letters soon. They will be mailed out about 45 days before each phase starts. For example, recipients will begin to receive letters for Phase 1 in the middle of October. For more information, please click on the following link:  http://ahca.myflorida.com/Medicaid/statewide_mc/pdf/mma/Dental_Overview_Final_081518.pdf

Dental Care: Why It's Important

It is important for babies, children, and adults to see a dentist at least twice a year. The earlier children see a dentist, the healthier their gums and teeth will stay for their whole life. Children should begin seeing a dentist by age 1, even if they do not have teeth yet.

Problems with teeth and gums can be avoided by seeing a dentist early in life and on a regular basis. Brushing, flossing and avoiding sugary foods and drinks can help with healthy teeth and gums.

If a tooth problem does occur, it can have serious effects on your overall health. Tooth problems can also cause problems like not being able to bite and chew food, problems in school, or missing school because of pain. Also, unhealthy teeth can cause problems with speaking.

Dental Care for Children Ages 0-20: What Florida Medicaid Covers

Florida Medicaid wants to make children are healthy. Below is a list of services that will help children have healthy teeth at no cost:
  • Dental Exams
  • Dental Screenings
  • Dental X-rays
  • Teeth Cleanings
  • Fluoride
  • Sealants
  • Oral Health Instructions
  • Space Maintainers
  • Fillings and Crowns
  • Root Canals
  • Periodontics
  • Prosthodontics
  • Orthodontics
  • Extractions
  • Sedation
  • Ambulatory Surgical Center or Hospital-based Dental Services

Some Services may require permission from a dental plan before the dentist performs the service. This is called a prior authorization. Services must be medically necessary in order for dental plans to pay for them. For more details about dental services, contact the recipient’s dental plan starting December 1, 2018.

Dental Care for Adults Ages 21 and Up: What Florida Medicaid Covers

Part of being healthy includes oral health care. Below is a list of emergency-based dental services covered by the dental plans starting December 1, 2018:
  • Dental Exams (limited)
  • Dental X-rays (limited)
  • Dentures
  • Extractions (removal of teeth)
  • Sedation (dental services while asleep or partly asleep)
  • Problem focused
  • Pain management

Some Services may require permission from a dental plan before the dentist performs the service. This is called a prior authorization. Services must be medically necessary in order for dental plans to pay for them. For more details about dental services, contact the recipient’s dental plan starting December 1, 2018.

If a recipient is 21 or older, they may be eligible to receive additional dental services. For pregnant women that are 21 years and older, more services may be available to help with a healthy pregnancy. The below dental services are expanded benefits starting December 1, 2018. These are extra goods or services the dental plans provide to adult and pregnant adult recipients, free of charge:
  • Additional dental exams
  • Dental screenings
  • Additional dental X-rays
  • Teeth Cleanings (basic and deep)
  • Fluoride Sealants
  • Oral Health Instructions
  • Fillings (silver and white)
  • Additional extractions
  • Dental consultations
  • Dental office diabetic testing
  • A visit to the dental office to get comfortable with the office and the dentist before dental work is done for persons with disabilities

Who pays for Florida Medicaid Dental Services?

Florida Medicaid dental plans pay for dental services. All dental services are provided through a dental plan starting December 1, 2018. To find a dental plan, use a computer and go to www.flmedicaidmanagedcare.com or call 1-877-711-3662 to talk to a Florida Medicaid Choice Counselor.

Find a Florida Medicaid Dentist

Florida Medicaid dental plans will help children and adults find a dentist and a dental home. Call a dental plan for help starting December 1, 2018.

Each dental plan’s Member Services Department can answer questions. Dental plans will help to choose or change dentists, find out if a service is covered, get referrals, find a provider, replace a lost ID card, and explain any changes that might affect dental benefits.

If a recipient does not know which Medicaid dental plan they have, that's okay. Use a computer and go to www.flmedicaidmanagedcare.com or call 1-877-711-3662 to talk to a Choice Counselor. Call the dental plan for help finding a dentist.

Transportation to the Dentist

Your Medicaid health plan provides transportation to a dentist appointment, if needed. Ask your health plan for help if you need a ride.

Have a Problem?

Your oral health is important and we are committed to ensuring that you receive high quality care. If you have any problems, such as getting a ride to the dentist, scheduling an appointment or receiving prior authorization for a service, please contact the Florida Statewide Medicaid Managed Care Program Complaint Center if you need assistance filing your complaint or wish to tell a person, please call toll free 1-877-254-1055; Telecommunications device for the deaf (TDD) 1-866-467-4970 to speak to a Medicaid representative.