Medicaid and CHIP

The ADA’s Health Policy Institute and the Association of Dental Support Organizations recently published a report recommending reforms to federal and state public policy that would make it easier for dentists to enroll in Medicaid and for patients to access critical oral health services.

These reforms include

• Improved Medicaid coverage and reimbursement rates
• Streamlined administrative requirements, especially for prior authorization and credentialing
• A diversified dental workforce
• Community-based dental school programs
• Student loan forgiveness programs
• Licensure portability

View the white paper here.

The Association's priorities are based on the major policies and positions (Members Only) adopted by the ADA House of Delegates. (PDF)

• Maintaining the federal requirement for states to cover dental services under the Medicaid Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program.
• Requiring states to cover dental services for Medicaid-eligible adults, and exempt all preventive dental services from cost-sharing requirements.
• Preserving the federal financing role in the Medicaid program and update the federal matching formula to address economic changes.
• Enhancing the federal Medicaid matching rate to 90/10 for dental care.
• Maintaining the federal requirement for states to cover dental services in their respective CHIP programs.

• October 2, 2024 — Letter to the House Energy and Commerce Committee supporting the recent approval of key pieces of legislation during the Committee's markup, including H.R. 670 and H.R. 8107. (PDF)
• November 7, 2023 — Joint letter to Congressional leadership in support of the Children’s Health Insurance Program Permanency Act. (PDF)
• April 11, 2023 — Dental coalition letter to Congressman Mike Simpson, DMD, to thank him for introducing H.R. 1422, the Strengthening Medicaid Incentives for Licensees Enrolled in Dental (SMILED) Act, which would reduce administrative burdens in Medicaid, including audits and credentialing. (PDF)
• April 4, 2023 — ADA letter to Congressman Mike Simpson, DMD, to thank him for introducing H.R. 1422, the Strengthening Medicaid Incentives for Licensees Enrolled in Dental (SMILED) Act, which would reduce administrative burdens in Medicaid, including audits and credentialing. (PDF)
• March 21, 2023 — Letter sent to Congress in support of the Medicaid Dental Benefit Act (PDF)
• March 17, 2023 — Letter to Senator Ben Cardin thanking him for introducing the Medicaid Dental Benefits Act, which would make comprehensive dental care a mandatory component of Medicaid coverage for adults in every state (PDF)
• September 29, 2022 — Partnership for Medicaid to Congress addressing the Medicaid fiscal cliff in Puerto Rico and the territories (PDF)
• July 7, 2022 — Coalition letter to congressional leaders urging their support for H.R.4439, the Medicaid Dental Benefit Act and S. 3166, the Medicaid Dental Benefits Act of 2021. (PDF) These bills would make comprehensive dental care a required component of Medicaid coverage for adults in every state.
• June 22, 2022 — ADA hosts a virtual briefing for Capitol Hill staff handling health care policy with Marko Vujicic, Ph.D., Chief Economist and Vice President and Chelsea Fosse, D.M.D., M.P.H., Senior Health Policy Analyst at the ADA’s Health Policy Institute. The HPI team presented on “Making the Case for Dental Coverage for Adults in All State Medicaid Programs” and the challenges low-income adults currently face in accessing oral health care services. (PDF)
• April 1, 2022 — Coalition letter asking Congress to protect coverage for beneficiaries should lawmakers and the administration seek to unwind enhanced Medicaid protections related to the COVID-19 public health emergency. (PDF)
• February 17, 2022 — Coalition Letter from the ADA, AAPD, and AAOMS to the House Ways and Means Committee asking the Committee to support the coalition’s efforts to ensure equitable access to dental surgical services in hospitals and ambulatory surgical centers for children and adults with special needs and disabilities who have debilitating oral health problems and need access to timely treatment. (PDF)
• December 17, 2021 — Coalition letter calling for the Medicaid Dental Benefit Act to be included in the Senate’s Build Back Better reconciliation package (PDF). The Medicaid Dental Benefit Act would make comprehensive adult dental benefits a mandatory component of Medicaid coverage in every state.
• November 22, 2021 — Letter  to Senator Cardin to thank him for introducing S.3166, the Medicaid Dental Benefits Act. (PDF)
• October 13, 2020 — Letter of support to U.S. Rep. Gregorio Kilili Camacho Sablan for legislation, H.R. 6495 the Insular Area Medicaid Parity Act, that would lift the Medicaid funding cap in the U.S. Territories. (PDF)

• January 4, 2024 — ADA comments on the Centers for Medicare & Medicaid Services/Department of Health and Human Services 2025 Notice of Benefit and Payment Parameters rule (PDF)
• July 3, 2023 — Organized Dentistry Coalition (ODC) comments on the Medicaid fee for service rule (PDF)
• July 3, 2023 — Organized Dentistry Coalition (ODC) comments on the Medicaid managed care rule (PDF)
• June 29, 2023 — ADA comments on the Medicaid fee for service rule (PDF)
• June 29, 2023 — ADA comments on the Medicaid managed care rule (PDF)
• February 22, 2023 — Letter to the Centers for Medicare and Medicaid Services’ (CMS) chief dental officer regarding CMS exercising its oversight abilities as they pertain to Medicaid managed care organizations (MCOs) reporting of medical loss ratios (MLR) (PDF)
• January 31, 2023 — Joint comments with AAPD to the Centers for Medicare and Medicaid Services' (CMS) response to a request for information on essential health benefits (EHBs) (PDF)
• January 30, 2023 — Coalition Letter to the Centers for Medicare and Medicaid Services’ (CMS) Affordable Care Act (ACA) Notice of Benefit and Payment Parameters for 2024 (PDF)
• November 4, 2022 — Comments in response to the proposed CMS rule on streamlining Medicaid and CHIP eligibility, enrollment, and renewal (PDF)
• November 3, 2022 — Response to the Centers for Medicare and Medicaid Services’ (CMS) Request for Information on Promoting Efficiency and Equity Within CMS Programs, Including Medicaid (PDF)
• September 26, 2022 — Letter from the ADA and the Dental Quality Alliance (DQA) to the Centers for Medicare and Medicaid Services (CMS) supporting mandatory Medicaid and Children’s Health Insurance Program (CHIP) core set reporting (PDF)
• September 13, 2022 — Coalition comments urging CMS to consider including a single CDT code on the ambulatory surgical center list to be used to report covered dental procedures in ambulatory surgical center settings.(PDF)
• June 30, 2022 — Coalition letter ADA, AAPD, and AAOMS sent to the Directors of the Medicare and Medicaid Centers at CMS. (PDF) The letter follows up on past meetings with other officials at CMS and asks the heads of these centers for a meeting to address the dental community’s significant concerns regarding pediatric and adult patient access to dental rehabilitation surgery in hospital outpatient and ambulatory surgical center locations.
• April 6, 2022 — American Dental Association (ADA) response to the Centers for Medicare and Medicaid Services (CMS) Medicaid Request for Information (RFI) 2022 (PDF).
• April 1, 2022 — Coalition letter asking the Centers for Medicare and Medicaid Services (CMS) to protect coverage for beneficiaries should lawmakers and the administration seek to unwind enhanced Medicaid protections related to the COVID-19 public health emergency.(PDF)
• November 17, 2020 — Coalition Letter following up on meeting that ADA and AAPD held with Ms. Carol Blackford of CMS.(PDF)
• April 17, 2020 — Letter to Secretary Azar of HHS and Administrator Verma of CMS requesting Medicaid relief funds for Dentists.(PDF)
• March 5, 2020 — Letter to Health and Human Services Secretary Alex Azar thanking him for announcing the appointment of a Centers for Medicare and Medicaid Services (CMS) Chief Dental Officer, and asking for more information.(PDF)

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