MassHealth Budget Update 

Provider Letter June 2101

 The state budget has been approved by the House of Representatives, the Senate, and the Governor. Effective July 1, 2010, MassHealth adult dental benefits will be reduced to preventive and emergency services only (except for these members aged 21 and older who have been determined by the Department of Developmental Services to be eligible for DDS services).  MassHealth will no longer pay for the following adult services:

• Restorative
• Endodontic
• Periodontic
• Crowns
• Dentures
• Surgical procedures related to full or partial dentures

After July 1, 2010, dentists who are MassHealth providers will continue to be reimbursed for MassHealth patients for preventative and emergency care. If restorative services are needed, you may refer your patients to Community Health Centers (CHC), Hospital Licensed Health Centers, and/or  Acute Outpatient Hospitals or you request direct reimbursement from your patients for services rendered. At this time, the MDS believes that any multistep (i.e. crowns) procedure that is started before  July 1, 2010 needs to be completed by Septembers 30, 2010 to qualify for reimbursement.

There is no change in dental benefits for MassHealth members under age 21. In addition, MassHealth patients who are affected by these changes may access dental services through the Health Safety Net at community health centers that offer dental services.

The Massachusetts Dental Society is very disappointed in this budget decision and remains concerned about the impact on access to care for adults. The MDS wants to encourage you to continue to help the children on the MassHealth Program, which has a growing number of children in need of care.

If you have additional questions, you may contact the DentaQuest customer service at (800) 207-5019. The MDS will continue to update our Web site with related information as it becomes available.

Participating in MassHealth

It is still very important to join MassHealth to help treat the children in need of care. Your participation will give underserved children a dental home and help resolve the access to care crisis in Massachusetts. There is no change in dental benefits for MassHealth members under age 21.

MassHealth Member Participation - Drive to 65  

On February 19, 2009, the Massachusetts Dental Society (MDS) released the Call to ACTION, a plan to improve the oral health of Massachusetts residents by the year 2013. Contained within that plan is the following objective:

• A goal of increasing provider participation in the MassHealth Program to 65 percent of eligible MDS members by the year 2013.
• A goal of including 65 percent participation by specialists.

While this is an ambitious goal, it can certainly be achieved within the timeline set forth in the Call to ACTION. As a first step, a MassHealth Task Force was formed and charged to create and implement an action plan to recruit additional providers. Dr. John Fisher was appointed chair of this group. 

The Task Force is in the process of creating a "Drive to 65" implementation plan. The plan will require the participation of MDS leadership, district leaders, and the general membership, as well as collaboration with the Commonwealth and Doral Dental.