The following states have recently announced updates regarding dental benefits in their Medicaid programs.
In a request for proposals on Oct. 15, Oklahoma announced that it will be adding a limited adult dental benefit in Medicaid and expanding dental benefits for children under 21. The request is part of a larger push from Gov. Stitt (R) to move Oklahoma to managed care Medicaid plans known as SoonerSelect.
The adult benefit includes oral examinations and medically necessary extractions, with more expansive coverage contingent on the availability of federal funding. Oklahoma estimates the dental plan will cover 773,000 Oklahomans, including 175,000 adults in the expansion population. Plan operations would begin October 1, 2021.
The Centers for Medicare and Medicaid Services (CMS) announced its approval of a Section 1115 Medicaid Waiver for Nebraska, titled Heritage Health Adult Expansion Demonstration (HHA), which introduces a work requirement for the Nebraska Medicaid expansion population. This waiver is different from previous work requirement proposals in that it does not apply to the core medical benefits for the Medicaid expansion population. If an individual opts not to show that they meet the work or activity requirement they will still receive medical coverage (“Basic Benefits”) from Medicaid, but not dental, vision, or over the counter drugs (“Prime Benefits”). The Prime dental benefit includes dentures alongside dental services.
Potential Legal Challenges
Nebraska Governor Pete Ricketts (R) noted that the work requirement is “designed to withstand legal challenges.” Although the Basic Benefits package is available to any eligible adult, advocates have stated they still believe suits are still likely. If HHA does go to court, its legality may hinge on other work requirement decisions (Gresham v. Azar) and their application to dental coverage. Previous rulings have stated that work requirements are contradictory to the primary function of Medicaid, to “furnish medical assistance.”
CMS also approved a partial expansion of Medicaid in Georgia through an 1115 waiver, expanding coverage to adults earning up to 95% of the poverty line (FPL) who verify they meet work or activity requirements. Because the state did not expand Medicaid to the full eligible population (up to 138% of the FPL), Georgia will not receive enhanced federal matching dollars.
Please contact Government Relations Analyst Owen Urech with any comments or questions.