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Important Medicaid Update

As New York struggles to meet its ever-increasing Medicaid costs, Governor Cuomo and the Department of Health (DOH) are looking to managed care organizations (MCOs) to help reduce and control these costs. The Governor and the Medicaid Redesign Team have not called for a reduction in dental services in the coming year; however, several changes in the dental program will affect many covered patients and dentists who participate in the Medicaid program. Specifically, DOH plans to implement two important changes to the Medicaid dental program:

  • On July 1, 2012, DOH will require ALL managed care plans to offer dental coverage (except orthodontia - see below) to their Medicaid enrollees;

  • On October 1, 2012, DOH will end the carve-out of orthodontic services by requiring patients enrolled in MCOs to obtain their orthodontic care through their MCOs.

Patients that are NOT enrolled in an MCO will continue to receive their dental benefit fee-for-service.

Be sure to verify the patients eligibility and payment source at every appointment. If you are not participating in the beneficiary’s Managed Care Plan, you will not be paid.

Acrobat PDF FileGuide for Helping Medicaid Patients Enrolled in Managed Care