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Updated Draft Rule for the Medicaid Children’s Benefit

August 6, 2014

The state recently released an updated draft of the rules outlining approved Medicaid dental benefits for children ages 0 to 20. A copy of the draft children’s benefit rule can be accessed by clicking here. The draft children’s benefit rule addresses coverage for exams, diagnostic imaging, preventive, restorative, periodontal, prosthetic, oral surgery and anesthesia services. The document lists code descriptions for procedures and any frequency limitations or prior authorizations required. This rule does not address adult dental benefits or children’s orthodontic benefits, as these topics are addressed in separate rules.

The CDA has provided comments to the state Medicaid department on the previous draft of the children’s rule, and will continue to seek clarification on a few outstanding issues noted in the policy. We welcome CDA members to give additional feedback on this coverage standard. If you have comments to share, please e-mail them to This email address is being protected from spambots. You need JavaScript enabled to view it. by Thursday, Aug. 7.

Also, the final version of the Adult Dental Rule, which outlines the more comprehensive adult dental benefit that became available as of July 1, 2014, is available on the Code of Colorado Regulations Website (scroll to section 8.201 of the rule (page 17)). The final rule includes complete and partial dentures in the adult dental benefit. Complete and partial dentures both require prior authorization and will not be subject to the $1,000 annual maximum for dental services for adults age 21 and over. They will be subject to a set Medicaid allowable rate.



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