MedicaidCoverageHigh impact
MMP 23-13: Changes to Medicaid Dental Coverage
Michigan Medicaid - MDHHS·MI · Dentistry·Medical Policy
Effective date
Apr 1, 2023
We identified it
Jun 20, 2026
Summary
Michigan Medicaid is implementing a new service delivery model for adult dental benefits effective April 1, 2023, moving most beneficiaries ages 21+ to managed care plans for dental services. The policy also expands coverage for fluoride applications, sealants, crowns, root canals, and periodontal services with specific billing requirements and frequency limitations.
Action Required
By April 1, 2023: Billing team must verify enrollment status for all Michigan Medicaid dental patients ages 21+ to determine if services should be billed through their managed care plan or Medicaid FFS. Update billing workflows to check beneficiary health plan networks before scheduling. For crown procedures, verify eligibility using MDHHS frequency verification process and document expected 5-year prognosis in claim remarks. For root canal treatments, document tooth restorability and expected prognosis timeframe in claim remarks. Failure to verify managed care enrollment or complete required documentation may result in claim denials.