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 24, 2026
Summary
Medicaid dental coverage in Michigan is changing service delivery models effective April 1, 2023, moving adult beneficiaries (21+) enrolled in health plans to receive dental benefits through their health plan networks instead of fee-for-service. Additionally, coverage for fluoride treatments, sealants, crowns, root canals, and periodontal services has been expanded with specific billing requirements and frequency limitations.
Action Required
By April 1, 2023: Billing team must verify Medicaid beneficiary enrollment status to determine correct billing pathway - health plan network for adults 21+ enrolled in MHP/ICO/PACE, or Medicaid FFS for non-enrolled beneficiaries. Update billing procedures to include required attestations in claim remarks sections for crowns (5-year prognosis) and root canals (tooth restorability). Implement frequency verification process for crowns to avoid claim denials. Contact beneficiary health plans directly for prior authorization requirements as these may differ from Medicaid FFS requirements.