AHCA Announces Prepaid Dental Contracts Under Statewide Medicaid Managed Care Program

Feb 9, 2024
The Agency for Health Care Administration (AHCA) announced its intent to award contracts to MCNA Dental, DentaQuest of Florida and Liberty Dental Plan of Florida to provide dental services under the Statewide Medicaid Managed Care (SMMC) program. The dental plans will each provide services statewide.
Legislation passed during the 2016 Session that required AHCA to implement a statewide Medicaid prepaid dental health program (PDHP) for children and adults, separate from the current medical plans. Argus Dental and Vision and UnitedHealthcare of Florida both initially filed complaints with AHCA, giving notice of their intent to challenge the decision of awarding contracts to MCNA, DentaQuest and Liberty. Recently, UnitedHealthcare of Florida dropped its complaint regarding the contracts. AHCA still has the ability to negotiate with Argus before sending the complaint to administrative court.

The plans awarded contracts have committed to provide numerous added dental benefits to all adult Medicaid dental plan enrollees while children will continue to receive all medically necessary dental services. These services include additional diagnostic, preventive and periodontics services, and other benefits specifically targeted for pregnant women, all to be provided at no additional cost to the state.  For a complete list of all the adult dental expanded benefits, please click here.

In addition, AHCA has negotiated specific goals for the PDHP, including a 5 percent reduction in potentially preventable dental-related hospitalizations and visits to the emergency department in the first year and a 9 percent average reduction by the fifth year of the program. The dental plans also have committed to increasing access to preventive dental services such as annual dental visits and cleanings for children.

All full-benefit Medicaid recipients will be required to enroll in a dental plan to receive dental services, with very limited exceptions, which means all patients (both adults and children) receiving health care through a Managed Medical Assistance (MMA) health plan also must be enrolled in a dental plan. The dental plans have committed to allowing patients transitioning to a dental plan to keep their current dental provider for longer if the new PDHP causes them to have to switch to a different dental provider. The plans also have agreed to enter into agreements with all the other SMMC plans (MMA health and long-term care) to ensure coordination of benefits between all plans to ensure recipients can smoothly navigate between the different program components. For example, transportation costs to a dental appointment will be paid by the patient’s Medicaid health plan, not the dental plan. For a chart summarizing what a dental plan will cover versus what a health plan will cover, please click here.

The rollout for the SMMC health and dental plans will be done using a phased schedule beginning Dec. 1, 2018. To view a copy of the rollout schedule, click here.

Additional information will be provided to FDA members on the new dental contracts as it becomes available. If you have any questions or concerns, please contact the Director of Third Party Payer and Professional Affairs Casey Stoutamire, Esq. at 850.350.7202 or cstoutamire@floridadental.org.  

Capital Report, Vol. 25, No. 11 - July 30, 2018