Colorado Medicaid enrollees eligible for dental benefits

Adults enrolled in Colorado Medicaid are now eligible for dental benefits, an expansion of the program’s previous dental coverage, which was offered only to children and emergency adult patients.

Adults age 21 and older can receive benefits up to $1,000 per year under the new policy, which went into effect Tuesday. Legislation that enabled the expansion was passed in May 2013.

“Lack of preventive dental coverage can contribute to a range of serious health complications,´ said Susan Birch, executive director of the Colorado Department of Health Care Policy and Financing in a statement.

“This benefit will enable clients to get cleanings, minor fillings and diagnostic imaging services. Numerous studies have shown health teeth play a significant role in improving one’s self-esteem, impact economic opportunities and lead to a better quality of life,” Birch said.

The new benefit will be implemented in two phases.

The first phase began April 1 and covers basic adult preventive, diagnostic and minor restorative dental services, such as X-rays and minor fillings and treatment planning.

The second phase, beginning July 1, covers more comprehensive care, including root canals, crowns, partial dentures and other procedures that will require prior authorization.

Colorado is nearing the end of its fiscal year, which runs from July 1 to June 30 every year. Between April 1 and June 30, the Department of Health Care Policy and Financing plans to enroll about 46,000 adults under the new dental benefit, according to department spokesperson Marc Williams.

In fiscal 2014-15, enrollment is projected to reach about 89,000.

The expansion is funded through both federal and state dollars. Colorado’s share of the funding comes from a state fund that formerly funded Cover Colorado.

CoverColorado was created by the state legislature in 1991 to cover those individuals with pre-existing conditions that other carriers would not cover.  Elements of the Patient Protection and Affordable Care Act prohibit the rejection of patients for pre-existing conditions, rendering CoverColorado obsolete. The program’s authorizing legislation was repealed in July 2013, shutting down Cover Colorado.

The funds were shifted to the expansion of Medicaid’s dental benefit, Williams said.

For the remaining months in fiscal 2013-14, the expansion will cost $32 million, $11 million of which will be paid by Colorado. In fiscal 2014-15, the program will cost $86 million, with $22 million of that paid by Colorado.

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