Prepaid Dental Health Plans (PDHPs)
ANNOUNCEMENT: Effective immediately, the Agency has delayed the roll-out of the Statewide Prepaid Dental Health Program (PDHP) due to the budget proposal passed by the legislature and the accompanying statutory language passed in House Bill 5001 and House Bill 5003. Until further notice, the Statewide PDHP will continue to operate in Area 9 (Indian River, St. Lucie, Martin, Palm Beach and Okeechobee Counties), but will not expand into other Medicaid areas. Stopping select PDHP operations does not affect the Prepaid Dental Pilot Program that is currently operating in Miami-Dade County. The Agency is providing notice of this decision to affected parties and will provide additional information as it becomes available.
In the 2010 proviso language (Specific Appropriation 204 of HB 5001), the Agency was directed to implement a statewide Prepaid Dental Health Plan (PDHP). As a result, Florida Medicaid has contracted with two PDHPs, DentaQuest and MCNA Dental Plans, to provide children’s dental services in all Florida counties except Miami-Dade and the Reform counties, which are Baker, Broward, Clay, Duval, and Nassau. The Agency will implement the statewide dental expansion in stages. The map below shows the counties and timeline for the rollout.
Click on the Reference Information tab above to download a PDF version of this map or to contact an area office.
The PDHPs must cover all Medicaid State Plan dental services covered by Medicaid for children under 21 years of age. Except for children enrolled in Medicaid managed care plans offering optional dental services, and a few special services excluded groups, most Medicaid children will be required to enroll in one of the two PDHPs once the program goes live in their county of residence. The amount, duration, and scope of covered dental services will remain the same.
The first of many provider outreach opportunities for the Statewide PDHP was held on November 11, 2011. Providers in each area will have a chance to attend an informational session to be held in a central location and planned around the rollout schedule. Providers are encouraged to attend the meeting which best fits their needs.
Providers
Providers who are interested in becoming part of one or both of the Prepaid Dental Health Plan (PDHP) networks should contact the provider service toll-free number or visit their website.
MCNA Dental Plans
1 (855) 698-6262
DentaQuest
1 (877) 468-5581
Provider Outreach Meetings
Providers in each Medicaid area will have the opportunity to attend an informational session in a central location and planned around the rollout schedule. Please see the table below for the schedule of upcoming meetings. Please mark your calendar and keep checking this website and Provider Alerts for updates as they become available.
Please note: The first hour of each meeting is reserved for participants to meet-and-greet and to enjoy any refreshments that may be provided.
Statewide Prepaid Dental Health Plan Provider Outreach Meetings |
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Medicaid Area |
Date |
Location |
9 |
November 11, 2011 |
Palm Beach |
8 |
February 3, 2012 |
Holiday Inn Airport @ Town Center |
5 |
February 10, 2012 |
Holiday Inn St. Petersburg-Clearwater Airport |
4 |
February 17, 2012 |
Courtyard Daytona Beach |
2a |
February 23, 2012 |
AHCA Area 2a Office |
2b |
February 24, 2012 |
Hotel Duval |
7 |
March 2, 2012 |
Crowne Plaza Orlando Downtown Hotel |
1 |
March 9, 2012 |
Pensacola City Hall |
Services
Prepaid Dental Health Plans (PDHPs) are Medicaid managed dental care options available to Medicaid recipients who are
20 years of age or younger and not enrolled in a health plan that provides dental services.
Based on legislative mandate, the Agency will expand the PDHP program statewide in fiscal year 2011-2012.
The following services are managed by the PDHP:
- Adjunctive general services
- Dentures, full and partial
- Diagnostic examinations
- Endodontics/periodontal treatment
- Injectable medications
- Oral and maxillofacial surgery
- Orthodontic treatment
- Preventive services
- Radiographs
- Restorations
- Sealants
- Surgical procedures and extractions
Services included must be provided up to the limits specified by Medicaid and cannot be more restrictive.
Payment
If a recipient is enrolled in a PDHP, then the provider must bill the PDHP instead of billing straight fee-for-service Medicaid.
More than likely, the provider will need to join the PDHP’s network of providers to be able to provide services to the PDHP’s members.
How the PDHP reimburses the providers depends on the terms of the provider’s agreement with the PDHP.
Eligibility
The following Medicaid recipients are NOT eligible to enroll in a PDHP:
- Recipients 21 years of age or older.
- Recipients who reside in an intermediate care facility for the developmentally disabled or state hospitals.
- Recipients whose Medicaid eligibility is determined monthly through the Medically Needy Program.
- Recipients who are members of a Medicaid-funded health plan that provides dental services.
- Recipients who are in the Statewide Inpatient Psychiatric Program.
Recipients
At this time, the statewide PDHP is only available on Medicaid Area 9. This includes Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie Counties.
Who can participate? Children through Age 20 who have Medicaid or MediKids through age four. What are the names of the Dental Plans?
What if my child has special needs? The dental plans are able to handle children who have special needs. Covered Services: Both plans offer the same services that you had under Medicaid fee-for-service. Some examples are:
The plan will send you a member ID and a handbook with all the details. |
What if my child already has a Medicaid Dentist? Call the plan to see if your child’s dentist participates with the plan. If so (and you want to keep your dentist), tell your plan. What if my child’s dentist does not work with one of the dental plans? You will have to change dentists, but may be treated by your current dentist for up to one month after the new enrollment starts. What if my child has braces? The dental plan will continue to pay the same orthodontist for the braces. Call the new dental plan about continuing care until treatment is completed. What if we moved? Please report the new address to DCF or the Social Security Administration, or if your child is enrolled in MediKids, to the MediKids Helpline.
Statewide PDHP Welcome Letter: English [78KB] Statewide PDHP Welcome Letter: Spanish [82KB] |
Reference Information
Contact Medicaid Area Offices
Optional Dental Services
Non-Reform Health Plans that Cover State Plan Dental
Please remember that Non-Reform health plans may choose to cover State Plan dental services. We refer to this as "optional dental." If they choose to cover State Plan dental, then they receive extra capitation and are responsible for all State Plan dental services detailed in the Medicaid Provider Dental Services Coverage and Limitations Handbook.The following health plans will continue to cover optional dental services effective January 1, 2012:
- Molina
- Healthy Palm Beaches
- Integral
Please Note: Sunshine State Health Plan will no longer cover optional dental services beginning January 1, 2012.
Please be careful to request service authorization and to bill accordingly.
Map of Counties and Rollout Schedule [112KB]
AHCA RFP 007-10/11 - Statewide Prepaid Dental Health Plan [2.25MB]
Model Statewide Prepaid Dental Health Plan (SPDHP) Contract
Attachment I - Scope of Services [73KB] 
1/20/2012
Attachment II - Core Contract Provisions [724KB] 1/20/2012
FAQs
The Agency has received lots of questions concerning the Statewide Prepaid Dental Health Plan program. Please click the documents below to review the most common questions from providers and recipients. If you have a question, please send it to the PDHP Mailbox at statewide.PDHP@ahca.myflorida.com.
Provider FAQs [166KB]
Recipient FAQs [117KB]
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