April 1, 2014
Colorado’s limited adult Medicaid benefit is now available. Qualifying adults are able to visit a dental practice or clinic that is already enrolled in Medicaid and can accept Medicaid payments. The adult dental benefit allows Medicaid enrolled clients, age 21 years and over, to receive a number of basic dental services currently offered to children such as evaluations, diagnostic imaging, preventive and restorative services.
Adult Medicaid clients may receive up to $1,000 of the dental services per 12-month state fiscal year period (July 1 to June 30). Until July 1, 2014, the adult benefit will be limited to the dental services that are currently offered to children and do not require a prior authorization.
The state Medicaid department is developing a third-party administration system (similar to how CHP+ is administered) for both the adult and child Medicaid dental benefits. Under this administrator, a more comprehensive adult dental benefit is scheduled to begin on July 1. More details on the selected administrator of the program should be available in late March.
In the meantime, your practice may receive inquiries from patients seeking treatment through Medicaid.
- If you are already a Medicaid provider, you may start providing the limited services described to adult patients.
- Any office that would like to enroll as a Medicaid provider to start treating patients is welcome to learn more at http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1201542696393. (A helpful Webinar about becoming a Medicaid provider can be accessed at https://cohcpf.adobeconnect.com/tqy9sd7.4rfiko/.)
- It is expected that the third-party private administrator will help simplify and streamline the process for providers. The CDA will send additional detail once more information is available.
- If you are not enrolled in Medicaid, please consider referring patients to a practice or clinic that already accepts Medicaid for current treatment needs.
Fact Sheets & Helpful Documents
- Standard Provider Application (be sure to select your provider type on page 8)
- Adult Medicaid Dental Benefit Provider Frequently Asked Questions
- Adult Medicaid Dental Benefit and PETI Frequently Asked Questions for Providers & Nursing Facilities
- Medicaid Benefits for Patients
- Find a Medicaid Provider
- Adult Medicaid Dental Benefit Fact Sheet
- Adult Medicaid Dental Benefit and PETI Frequently Asked Questions for Clients
Questions? Call Medicaid Customer Service at 1-800-221-3943.