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Idaho, Illinois add adult dental benefits to state Medicaid programs

June 21, 2018

By Jennifer Garvin

Beginning July 1, Illinois and Idaho will each see adult dental benefits added to their state Medicaid programs.

On June 4, Illinois Gov. Bruce Rauner signed a budget that "for the first time, includes funding for dental prevention services for adult Medicaid recipients in Illinois," according to a statement from the Illinois State Dental Society. The legislation states that on July 1 the Illinois Department of Healthcare and Family Services will be required to provide adult dental services — including diagnostic, preventive, and restorative and services needed to treat periodontal disease — to all adults covered by Medicaid.

In remarks thanking Illinois legislators, state dental society President Barbara Mousel said preventive dental services are "critical" for all adults and they also give dentists "the opportunity to provide early interventions for not only dental disease but overall health as well."

In addition, the Illinois Department of Healthcare and Family Services will be required to monitor the relationship between the state's contracted managed care organizations and their dental administrators, adopt appropriate dental metrics, and publish the results in the Illinois Medicaid Plan Report Card and Health Plan Comparison Tool. The state agency will also collect data on how the managed care organizations implement their care coordination plans for dental care for certain patient populations such as pregnant women and those patients with diabetes.

The law also requires reimbursement rates for participating dentists be at the levels required by the 2005 court decree Memisovski vs. Maram; legislation enacted to improve access to care for children.

On July 1, Idaho will also see adult dental benefits restored for adults on Medicaid. The Idaho State Dental Association estimated that the new law will bring "basic dental care back to an estimated 29,000 adults who qualify for Medicaid."

The legislation "restores preventive dental care to the existing adult Medicaid population to the extent that it was provided prior to removal in 2011, and to the extent such services are defined by [the Social Security Act]."

This legislation also stated that the total cost of restoring the dental benefits is $3.8 million but said "70 percent of that cost is covered by federal funds."

Ensuring states have adult dental benefits is a key advocacy issue for the ADA. In 2017, Arizona voted to restore emergency dental benefits for adults in the state's Medicaid program, and in May, Maryland passed legislation requiring the Maryland Department of Health to implement a pilot program for adult dental coverage, which could begin as early as January 2019.