Wednesday, August 10, 2011

2011 Changes to Medicaid Dental and Vision Coverage

Budget cuts in the 2011 Biennial state budget created reductions in a number of services needed by individuals with developmental disabilities. Two programs had changes you need to be aware of. Below are the management bulletins explaining the changes.

Adult Dental Coverage

Effective July 1, 2011, comprehensive dental services were restored for three groups of Medicaid adults:
• Women who are pregnant
• Clients living in nursing homes
• Adults enrolled in 1915 (c) Home and Community Based waiver programs.

Effective October 1, 2011, the following clients will no longer be eligible for comprehensive dental services:

• Adult clients whose care is managed by the Division of Developmental Disabilities but who do not fit in the categories above.

The agency has developed a decision-making tool for providers to use to determine if a Medicaid-covered adult client meets this criteria and is eligible to receive the restored set of dental services. Medicaid also has developed policy for “How to Bill” under these criteria.

A formal provider memo communication, web access to the decision-making tool, and a set of Frequently Asked Questions (FAQ) will soon be available on the dental home page at:

Clients who are eligible for these services may already have received services since July 1 or be scheduled to receive services in the future. Medicaid will reimburse providers for this care. The decision-making tool and the memo will include expedited authorization numbers for each of the eligible groups listed above. Once you have established eligibility, you can bill for these clients’ services using those numbers.

The change in dental coverage for adults with developmental disabilities was intended to become effective July 1, but that date did not allow time to rearrange Medicaid coverage and provide required notice to clients.

There is no change in covered dental services for children – clients 20 years of age or younger. There is also no change in prior authorization requirements.

Adult clients other than the specific groups listed above are not eligible for comprehensive dental services. They are restricted to the emergency oral health benefit implemented on January 1, 2011.

Adult Vision Services

Medicaid providers can now obtain low-cost eyeglass frames and lenses for Medicaid clients who otherwise might not be able to afford vision hardware because of state budget cuts.

Legislation passed this year and signed by Governor Gregoire allows Airway Heights' Correctional Industries Optical Center to continue making vision hardware for Medicaid providers and patients. Under the law, providers can furnish the eyewear to Medicaid patients at the same cost they pay the Optical Center. Prices are expected to range around $20 for a pair of glasses.

The vision benefit budget cut was one of several changes affecting coverage for clients of the Medicaid program ages 21 and older. None of the changes affected children’s benefits, which are generally protected under federal Medicaid law. The cuts also did not change coverage of eye or hearing exams for adults. Those remain covered by Medicaid.

• More information about the bill and copies of the legislation are available on the Internet at:
• Additional information also will be posted on the Airway Heights web page soon:
• Providers are reminded that dispensing codes 92340-92342 are still valid codes, and that Medicaid will reimburse providers for dispensing the glasses.

Substitute Senate Bill 5352, was originally sponsored by Senators Jim Honeyford, R-15, Debbie Regala, D-27, and Dan Swecker, R-20. It passed both chambers unanimously and was signed by Governor Gregoire on April 18.

What's Next?

Because the state must keep a balanced budget in line with the quarterly revenue forecasts, we can expect additional cuts to services and programs. The July revenue forecast was worse than expected and the September forecast will likely bring more of the same news, as recovery is happening slower than anticipated.

Your voice in the legislative process is needed now, more than ever! Be sureyou aresigned up for The Arc's Action Nework, and whether by email, phone or other communication, make sure your legislators know the effect of making additional cuts to the services you, your friends and family, as well as many others in this state need. It is approximated that there are about 80,000 people in Washington State who have a developmental disability. Be one of those making your voice heard! Sign up for Action Alerts at

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