HHSC Temporarily Suspends Dental Home Requirement

Texas Health and Human Services Commission (HHSC) is delaying the restriction that a Medicaid client must be served by their assigned main dentist through April 30, 2012. This will give clients more time to notify their dental plan of their preferred dentist without any disruption in service.

As of March 1, 2012, most children and young adults age 20 and younger enrolled in Medicaid began receiving their dental services through one of the three dental plans: Delta Dental, DentaQuest, and MCNA Dental. Additionally, the CHIP dental benefit also was expanded from one dental plan to all three. As part of the change to these dental plans, clients also were asked to choose a main dental home (or main dentist), who is responsible for providing initial and primary care to patients, maintaining the continuity of patient care, and initiating referrals for care when appropriate. If a client did not choose a main dentist, the dental plans assigned a main dentist to the member based on claims data for the past year. Medicaid clients can change their main dentist at any time by contacting their dental plan.

HHSC has been made aware of concerns that a high number of clients may want to change their main dentist as they begin receiving notice of the provider assigned to them. Effective immediately, to avoid delays in access to care, HHSC is temporarily suspending the restriction that a member must be served in their main dental home. This suspension will continue through April 30, 2012. This will give members time to contact their dental plan and choose their preferred dental provider without any disruption in service. Dentists should continue to see Medicaid patients they have scheduled and encourage them to contact their dental plan to choose their main dentist if they have not already done so.

Reprinted with permission from HHSC (March 2, 2012)