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Update: 2014 Adult Medicaid Dental Benefit

November 8, 2013

Colorado recently announced that it will seek applications from administrative service organizations (ASO’s), usually private insurance plans, to manage the state’s Medicaid dental benefits. Medicaid will select a single vendor to act as the ASO for both the children’s and adult’s dental benefits under Medicaid. The new arrangement is anticipated to begin in the spring of 2014. Medicaid released a draft proposal for interested vendors in mid-October. The CDA submitted several suggestions to ensure providers are protected in the ASO arrangement, including:
• vendor requirements for prompt payment
• language prohibiting the vendor from requiring Medicaid providers to accept their commercial plans
• clarification on reasons for provider termination
• streamlining a system for prior authorizations

A copy of the CDA’s comments may be viewed by clicking here.

In addition, Medicaid continues to gather stakeholder input on what services the new adult dental benefit should include. The adult dental coverage proposed to date has been broad and inclusive. However, funding limitations may eventually limit the breadth of services available. 

Past stakeholder meetings have discussed coverage for diagnostic, preventive, restorative, endodontic, oral surgery, prosthetic, pediatric and orthodontic dental services. One remaining stakeholder meeting on Dec. 6 will discuss pediatric and hospital-based dentistry. An additional stakeholder meeting may be scheduled to discuss topics not already covered, such as payment rates and provider network sufficiency. Interested dentists are encouraged to participate in these stakeholder meetings. Dates and times are subject to change and up-to-date information can be obtained from the Medicaid dental benefit stakeholder Website at http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1236690494893.



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