Keeping your teeth and gums clean and healthy gives you more than just a pretty smile. Oral health is very important to your overall health and wellness. Dental care helps keep harmful bacteria from entering your bloodstream and spreading to other organs where it can lead to problems with your heart or lungs. Dental problems can even contribute to complications from diabetes or Alzheimer’s disease.
While not all states cover dental services through their Medicaid program, healthy teeth and gums are a top priority here in Delaware. The Division of Medicaid and Medical Assistance now offers a wide variety of adult preventive and restorative dental services—including exams, cleanings and fillings—to make sure Delawareans covered by Medicaid have access to the dental care they need.
Medicaid-enrolled adults age 21 or older are eligible to receive up to $1,000 of dental care per year. An additional $1,500 may be available for qualifying emergency or supplemental care when medically necessary.
Dental services are available to Delaware adults enrolled in either Home and Community-Based and Long Term Care Medicaid programs.
How and when do I enroll in for dental coverage?
There is no special enrollment into Delaware’s dental program. Members enrolled in managed care will receive their adult dental services through their managed care plan. Individuals enrolled in fee-for-service (FFS) Medicaid will receive their adult dental services through the FFS program.
Is there a copay for dental services?
How do I find a participating dentist?
Check with your managed care plan for a list of participating credentialed dental providers.
How many cleanings are covered each year?
The plan allows for one cleaning every six months.
Is sedation covered?
Yes. Sedation, including IV sedation, is covered and is not limited to any particular type of service. The use of sedation is based on medical need. Sedation services do require prior authorization.
Does the oral surgery benefit include wisdom teeth?
Regular tooth extractions are covered under the Adult Dental Benefit.
Wisdom tooth removal is a covered benefit, but it is under your Medicaid medical benefit, not dental.
Are Medicare participants covered?
This is a Medicaid program. Full dual enrollees (Medicare/Medicaid) members will have access to Adult Dental Benefits. Those who are enrolled as Qualified Medicare Beneficiary (QMB) and Specified Low-income Medicare Beneficiary (SLMB) only are not eligible for dental benefits under this program
Dentists who wish to provide adult dental services in the Medicaid fee-for-service (FFS) program must enroll as a Medicaid dental provider under one of these taxonomies.
Important information for Dental Providers about Medicaid Dental Services
For more information, contact Provider Services at 1-800-999-3371 (Option 0, then Option 4) or MedicaidInfo@delaware.gov
Important Links
- Dental Co-Pay Announcement
- 1115 Dental Amendment – Public Notice
- 1115 Dental Amendment – Waiver Request
- Adult Dental Member FAQ Delaware
- Adult Dental Provider FAQ Delaware
- Adult Dental Public Meetings 7.15.20
- Adult Dental Codes and Descriptions 10.14.20
- Update Delaware Not Enrolled in DMAP Fact Sheet 10.5.20
- Update Delaware Enrolled Dental Provider Fact Sheet 10.5.20
- Update Delaware Dental Society Provider Enrollment 10.5.20
