State Children's Health Insurance Program: Dental Health Care Services

Health Care Program

State Children's Health Insurance Program (SCHIP):
Dental Health Care Services

Updated: December 1999

States choosing a Medicaid expansion under SCHIP, even under a combination plan, must provide standard Medicaid dental benefits for children covered under the Medicaid program.

For the purpose of this chart, dental services have been categorized into two groups: preventive, diagnostic, basic and restorative services and advanced treatment services. In the first category, services may include topical fluoride treatment, x-rays, fillings, sealants and acute emergency dental services. In the latter category, services may include crowns, bridges and surgery such as root canals.

Co-payments for advanced treatment services vary from state to state.

State/ Territory	Provider	E Preventive, Diagnostic, Basic & Restorative Services	¨ Advanced Treatment Services	Co-payments (Non-Preventive or Diagnostic Services)	Orthodontics
Alabama (combination plan)	Network	Yes	Yes	Yes	Special needs only
Alaska	MEDICAID EXPANSION - EPSDT COVERAGE
Arizona (state-designed plan)	HMO	Yes	Yes	Yes (above 150% of poverty)	Medically necessary only
Arkansas	MEDICAID EXPANSION - EPSDT COVERAGE
American Samoa	MEDICAID EXPANSION - EPSDT COVERAGE
California (combination plan)	HMO/PPO	Yes	Yes	Yes	Prior approval required
Colorado (state-designed plan)	NA	No	No	NA	No
Connecticut (combination plan)	HMO	Yes	Yes	Yes (extractions, root canals etc.)	Yes (with limits)
Delaware (state-designed plan)	NA	No	No	NA	NA
District of Columbia	MEDICAID EXPANSION - EPSDT COVERAGE
*Florida (combination plan)	NA	No	No	NA	NA
Georgia (state-designed plan)	Existing Medicaid system	Yes	Prior approval required	No	Prior approval required
Guam	MEDICAID EXPANSION - EPSDT COVERAGE
Hawaii	MEDICAID EXPANSION - EPSDT COVERAGE
Idaho	MEDICAID EXPANSION - EPSDT COVERAGE
Illinois	MEDICAID EXPANSION - EPSDT COVERAGE
Indiana	MEDICAID EXPANSION - EPSDT COVERAGE
Iowa	MEDICAID EXPANSION - EPSDT COVERAGE
Kansas (state-designed plan)	Private contractors	Yes	No (some exceptions)	No	No
Kentucky (combination plan)	Plan providers	Yes	Yes	Yes	No
Louisiana	MEDICAID EXPANSION - EPSDT COVERAGE
Maine (combination plan)	Existing Medicaid system	Yes	Yes	No	Prior approval required
Maryland	MEDICAID EXPANSION - EPSDT COVERAGE
Massachusetts (combination plan)	BC/BS/PPO	Yes	Yes	No	Yes
Michigan (combination plan)	HMO/PPO	Yes	Yes	Only extractions and crowns	No
Minnesota	MEDICAID EXPANSION - EPSDT COVERAGE
Mississippi (combination plan)	Will accept bids	Yes	Yes	No	No
Missouri	MEDICAID EXPANSION - EPSDT COVERAGE
**Montana (state-designed plan)	In planning stage	Planning to provide	In planning stage	In planing stage	Not planning to provide
Nebraska	MEDICAID EXPANSION - EPSDT COVERAGE
Nevada (state-designed plan)	Maybe HMO	Yes	Yes	Yes	Medically necessary only
New Hampshire (combination plan)	HMO	Yes	No (some exceptions)	Yes	No
New Jersey (combination plan)	HMO	Yes	Yes	Yes	Prior authorization
New Mexico	MEDICAID EXPANSION - EPSDT COVERAGE
New York (state-designed plan)	Network or sub-contractors	Yes	Yes (as appropriate)	No	No
North Carolina (state-designed plan)	Existing delivery system	Yes	Yes	Yes	No
North Dakota (combination plan)	MEDICAID EXPANSION - EPSDT COVERAGE
N. Mariana Islands	MEDICAID EXPANSION - EPSDT COVERAGE
Ohio	MEDICAID EXPANSION - EPSDT COVERAGE
Oklahoma	MEDICAID EXPANSION - EPSDT COVERAGE
Oregon (state-designed plan)	DCO	Yes	Yes	No	No
Pennsylvania (state-designed plan)	HMO	Yes	Yes	No	No
Puerto Rico	MEDICAID EXPANSION - EPSDT COVERAGE
Rhode Island	MEDICAID EXPANSION - EPSDT COVERAGE
South Carolina	MEDICAID EXPANSION - EPSDT COVERAGE
South Dakota	MEDICAID EXPANSION - EPSDT COVERAGE
Tennessee	MEDICAID EXPANSION - EPSDT COVERAGE
Texas (combination plan)	MEDICAID EXPANSION - EPSDT COVERAGE
U.S. Virgin Island	MEDICAID EXPANSION - EPSDT COVERAGE
Utah (state-designed plan)	Public Employees Dental Network	Yes	Yes	Yes (co-insurance)	No
Vermont (state-designed plan)	Existing Medicaid system	Yes	Yes	Yes	Prior approval required
Virginia (state-designed plan)	Existing system	Yes	Yes	No	Prior approval required
Washington (state-designed plan)	Existing Medicaid system	Yes	Medically necessary only	No	Medically necessary only
West Virginia (combination plan)	FFS-Essential Community Health Care Providers	Yes	Yes	No	Medically necessary only
Wisconsin	MEDICAID EXPANSION
Wyoming (state-designed plan)	FFS	Yes	Yes	No	Medically necessary only

Source: Health Care Financing Administration (HCFA) state SCHIP fact sheets, National Conference of State Legislatures and National Governor's Association State Children's Health Insurance Program Annual Report, and personal communication with state SCHIP program contacts. Information is based on plans that have been approved.

E Services may include topical fluoride treatment, x-rays, fillings, sealants and acute emergency dental services
¨ Services may include crowns, bridges and surgery such as root canals
* Dental services in Florida may be covered at each county's option.
** MT governor signed legislation on 5/6/99 establishing SCHIP, providing for dental benefits. Benefits begin in October 1999. Dental coverage will not exceed $200 per child per year. The state is in the process of designing the dental benefit package.

DCO = Dental Care Organization
FFS = fee for service
HMO = health maintenance organization
PPO = preferred provider organization

For further information on SCHIP, please see NCSL's STATESERV website at http://www.stateserv.hpts.org/public/pubhome.nsf.

Other SCHIP Resources

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Health Care Program

State Children's Health Insurance Program (SCHIP): Dental Health Care Services

State Children's Health Insurance Program (SCHIP):
Dental Health Care Services