Dental Benefits For Children In Medicaid
Medicaid covers dental services for all child enrollees as part of a comprehensive set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment benefit. Though oral screening may be part of a physical exam, it does not substitute for a dental examination performed by a dentist. A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state.
Dental services for children must minimally include:
- Relief of pain and infections
- Restoration of teeth
- Maintenance of dental health
The EPSDT benefit requires that all services must be provided if determined medically necessary. States determine medical necessity. If a condition requiring treatment is discovered during a screening, the state must provide the necessary services to treat that condition, whether or not such services are included in a state’s Medicaid plan.
Each state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health care. Dental services may not be limited to emergency services for children entitled to EPSDT.
Important Information About Hurricane Ian
Due to Hurricane Ian:
- Prior authorization requirements for medical services will be relaxed, until further notice.
- If there are refills on your medication and you need to fill sooner than you usually do, you may obtain them even if it is too early.
- You may experience longer than usual hold times when calling us.
- Medications may be filled at any pharmacies in any state, until further notice. Use of out-of-network pharmacies is authorized when access to in-network pharmacies is unavailable.Use of out-of-network or out-of-state providers will be allowed for medically necessary services.
- Medically necessary emergency or urgent care will be covered. If you are having an emergency, call 911.
My Health Pays Rewards Program
Earn dollar rewards on your My Health Pays® Visa® Prepaid Card** for making healthy choices.
Ways to earn include getting a fu shot, a wellness checkup, or a health screening.
Spend your rewards at Walmart® on personal care items, diapers, and healthy food. Also spend them on necessities like rent, utilities, and child care.***
For more information about Absolute Total Cares Member Rewards Program, visit our Rewards Program webpage.
**This card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank Member FDIC. Card cannot be used everywhere Visa debit cards are accepted. See Cardholder Agreement for complete usage restrictions. ***This card may not be used to buy alcohol, tobacco, or fiearms products.
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My First Trip To The Office
Generally, children should visit the dentist by their first birthday or when their first tooth comes in. To make sure your child develops healthy dental habits, seeing the dentist early and regularly will really help. Your dentist can teach your child proper dental care, helping them prevent tooth decay and live a lifetime of happy, healthy smiles.
Tips to help with your childs first dentist appointment:
Prepare your child
You can get your child used to a dentist check-up at home before ever scheduling their first appointment. You can do this early for babies by wiping their gums with a soft cloth after meals or gently brushing their tooth with a soft toothbrush. Doing this before their first appointment will get them used to having someone exam inside their mouth. If your child is older, give them a general idea of what to expect and explain why going to the dentist is important.
Pediatric Dentist In Greenwood Sc 29649
At Kids First Dental, we strive to create a comfy atmosphere for all ages. We know the dentist can be scary at times, but we are here to ease your worries. Our expert dentists and dedicated staff look forward to providing you a memorable experience at our dentistry. Book an appointment with us today, and get to know our staff!
- Monday8:00 AM – 5:00 PM
- Tuesday8:00 AM – 5:00 PM
- Wednesday8:00 AM – 5:00 PM
- Thursday8:00 AM – 5:00 PM
- Friday7:30 AM – 3:30 PM
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South Carolina Medicaid Eligibility Requirements
Medicaid eligibility is not always black and white. The Healthy Connections program includes several categories of eligibility: Aged and blind or disabled, breast and cervical cancer, disabled children, family planning, former foster care, nursing home residents, medically needy, parents and caretaker relatives, partners for healthy children, pregnant women and infants, qualifying Medicare beneficiaries, and working disabled people. The chart below can help you determine whether or not you qualify:
Why Dental Care Is Important
Part of being healthy is oral health care. Problems with your teeth can affect your overall health. Tooth problems can cause problems like:
- Not being able to bite and chew food
- Missing school or work because of pain
- Having trouble speaking, especially if you have unhealthy teeth
Regular visits with your dentist can help prevent problems before they develop. If you have problems with your teeth or gums, a dentist can diagnose and treat you.
Humana Healthy Horizons in South Carolina
If you have questions, find the number you need to get help and support.
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State Oral Health Action Plans
To support the Oral health Initiative, CMS invited state Medicaid agencies to develop State Oral Health Action Plans as a roadmap to achieving in their goals.
CMS has received SOHAPs from the following 25 states: Alabama, Alaska, Arizona, California, Connecticut, District of Columbia, Delaware, Florida, Maine, , Massachusetts, Michigan, Missouri, Nebraska, New Hampshire, New Jersey, North Dakota, Oklahoma, Pennsylvania, Tennessee, Utah, Vermont, Virginia, Washington and Wyoming. CMS encourages the remaining 29 states to develop and submit their SOHAPs, and CMS stands ready to provide technical assistance to any state that requests it.
SOHAPs may be submitted using either a CMS-developed Oral Health Action Plan Template or a user-friendly template developed by the Medicaid-CHIP State Dental Association. Completed SOHAPs may be submitted to Andrew Snyder, Health Insurance Specialist via email to with a copy to your CMS Regional Office contact. Any questions about the SOHAPs may also be directed to Mr. Snyder.
Organized Health Care Arrangement
First Choice Community Healthcare, Inc. currently participates in an Organized Health Care Arrangement with the University of New Mexico Health Sciences Center . We do this to support and improve the provision and quality of health care services to our patient populations. As an OHCA partner, we share access to UNM HSC’s electronic medical records and may, under certain circumstances and without seeking other advance authorization, access shared patient medical and billing information as part of our activities to improve, manage, and coordinate care, but only to the extent permitted by law. Current partners are listed below.
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Every Step Of The Way 2019/2020 Report To The Community
Our whole-person approach is serving members throughout the state by providing access to far more than clinical care. Through partnerships with community organizations, local businesses, state government, and many caring individuals, we are addressing the various social issues that affect a persons health, including healthy lifestyles, support networks, education, and technology supports.
*First Choice by Select Health rated higher by network providers than all other Medicaid plans in South Carolina, according to an independent provider satisfaction survey by SPH Analytics, a Press Ganey Solution and National Committee for Quality Assurance-certified vendor, February 2022.
Special Circumstances For Adult Beneficiaries Over Age 21
On February 1, 2011, beneficiaries over age 21 were no longer eligible for general dental services including emergency services. Only under the following circumstances related to the treatment of medical conditions that as a part of the course of treatment require dental extractions to eliminate oral infection that can have a negative impact on the outcome of the treatment. A list of medical conditions that qualify as special circumstances, can be located in the Office Reference Manual located on the DentaQuest web portal.
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Cost & Insurance Faq’s
At Little River Medical Center, we provide services to all and can adjust fees based on ability to pay. Whether youre fully insured, under-insured, or lack insurance, we want you to know you are well cared-for and that we are focused on saving you money.
Can you tell me the cost before my appointment?Please know that exact charges are based on specific services and cannot be quoted exactly before your visit. Lab work and other tests can impact the cost of your visit. For dental visits, necessary services along with the location and condition of your tooth can impact the cost of your treatment.
You will be asked to pay a fee at the time of your visit which will vary by the type of service you receive, copays and your sliding fee determination, if applicable. Additional charges or fees not paid at time of visit, if owed, will be billed to you with eligible discounts applied.
What kind of insurances does Little River Medical Center accept?We accept most insurance plans and networks, and Medicare and Medicaid. You are encouraged to contact the number on the back of your insurance card prior to your visit to verify coverage, copay and that your plan considers Little River Medical Center in-network. Confirming this information with your insurance company in advance will help you avoid any unforeseen charges.
Sc Healthy Connections Dental Program & Vision Coverage
Adults in the SC Healthy Connections Dental Program can receive preventative services of up to $750 in value per year. This includes annual cleanings and exams, x-rays, extractions, and fillings. Most people will pay a $3.40 copayment. Kids also get six-month fluoride treatments, one sealant every three years, and one space maintainer. These services are provided through Dentaquest, so you can find a provider at the SC Dentaquest website.
Vision coverage is also much more comprehensive for kids than it is for adults. While kids can get coverage for both exams and glasses, adults can only receive medically necessary exams, like for those pertaining to eye diseases like glaucoma.
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What Does Sc Medicaid Cover
There are five South Carolina Medicaid plans, all of which are very similar. Plans are Absolute Total Care, Healthy Blue by BlueChoice of SC, First Choice by Select Health of South Carolina, WellCare, and Molina Healthcare of SC.
Most SC Medicaid services are free or have a very low copayment . The South Carolina Medicaid program is quite comprehensive. In general, SC Medicaid covers:
Adults can receive a wellness visit every two years, and kids under the age of 21 can receive one every year .
Commercial Health Exchange And Marketplace Plans For Musc Health
- Ambetter from Absolute Total Care
- BCBS Blue Essentials
- Blue Choice Blue Option
- Blue Cross Blue Shield Plans including:
- Blue Choice HealthCare
- State Health Plan for South Carolina
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Complete Dental Care For The Whole Family
- General Info
- First Choice Dental, located in Greenwood, SC, provides quality dental care for all ages. From cleaning and whitening to extractions, root canals, crowns dentures and more! First Choice Dental is a member of the SCDA and the ADA. The staff at First Choice Dental will make you feel right at home! First Choice Dental accepts Care Credit and Medicaid and most other insurances are accepted. Services provided – – Preventative – Restorative – Crowns and Bridges – Dentures and Partials – Root Canals – Whitening – Extractions Call today to schedule your appointment!
- Payment method
Cms Learning Lab: Improving Oral Health Through Access
The Center for Medicaid and CHIP Services at the Centers for Medicare & Medicaid Services is hosting a series of webinars to support States and their collaborative partners to improve access to dental services for children enrolled in Medicaid and CHIP. The webinar materials are available below. For more information about the CMS Oral Health Initiative and the CMS Learning Lab webinars, see the .
Reducing Early Childhood Tooth Decay: Approaches in Medicaid May 27, 2015
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Medicaid And Health Choice Dental Providers
Beneficiaries have two choices to find a dentist in North Carolina.
To find a dentist in North Carolina using the Insure Kids Now Website , please use the following link:
IMPORTANT: Before making an appointment, please call the dental office to verify that beneficiaries are currently being accepted. A dentist or facility shown on the list is not a guarantee that beneficiaries are currently accepted.
To find a dentist in North Carolina using the Medicaid and NC Health Choice Provider and Health Plan Lookup Tool, please use the following link:
IMPORTANT:
- If you know the provider by their last name, search by Provider for a Plan. Enter at least a portion of the last name, a location, and use the specialty drop down to choose the type of dental provider to search.
- If you know the practice name where the provider works, search by Organization for a Plan. Enter at least a portion of the practice name, a location, and use the specialty drop down to choose the type of dental provider to search.
- If you do not know the PCP you want to choose, go to Search by Health Plan for an Organization. Select NC Medicaid Direct in the Health Plan field, a location, and use the specialty drop down to choose the type of dental provider to search.
- If you use this option to find a new dentist, you must still call the Medicaid Contact Center or your local DSS office to ask for the change.
South Carolina Medicaid And Medicare Assistance
If you qualify for both Medicaid and Medicare, you can also qualify for a Medicare Advantage dual-special needs plan. These plans can save you money and provide additional coverage. To find out more about dual-special needs plans in your area, or to speak with a licensed agent in North Carolina, fill out this form or call us at 833-438-3676.
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Dental Care For Medicaid Recipients In South Carolina
Medicaid recipients in South Carolina get some dental coverage through the state:
- Routine and emergency dental services are available to members under the age of 21
- Limited dental services are available to members age 21 and older
While your medical and health coverage is with Humana Healthy Horizons in South Carolina, your dental coverage is through the state. Learn more at South Carolina Healthy Connections Medicaid, opens new window
Healthy Connections Now Provides Adult Dental Benefits
Dental health is a key part of improving and maintaining your health. The health of your teeth and gums can affect the health of the rest of your body. Healthy Connections recognizes this fact and now covers preventive dental services, up to $750 per fiscal year, for adult members. The new services offered include:
- An annual cleaning
These new services are available to members age 21 and older who have full Healthy Connections Medicaid benefits. There is a $3.40 copayment for adult Healthy Connections Medicaid members toward the cost of preventive care. The new benefit does not cover crowns, root canals, periodontal scaling and root planing, teeth whitening or dentures.
Members may locate a participating dental provider by visiting the Dentaquest website at dentaquest.com or calling 1 307-6552.
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Dental Benefits For Children In Chip
States that provide CHIP coverage to children through a Medicaid expansion program are required to provide the EPSDT benefit. Dental coverage in separate CHIP programs is required to include coverage for dental services “necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.”
States with a program may choose from two options for providing dental coverage: a package of dental benefits that meets the CHIP requirements, or a benchmark dental benefit package. The benchmark dental package must be substantially equal to the the most popular federal employee dental plan for dependents, the most popular plan selected for dependents in the state’s employee dental plan, or dental coverage offered through the most popular commercial insurer in the state.
States are also required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages on InsureKidsNow.gov.
Our Top Contracted Insurance Carriers Are:
- Absolute Total Care
- BlueCross BlueShield of North Carolina
- BlueCross BlueShield of South Carolina
- BlueChoice HealthPlan of South Carolina
- Centene Corporation
- First Choice by Select Health of SC
- Medicaid South Carolina and North Carolina
- Select Health of South Carolina
- United HealthCare of SC
What type of payment is accepted?You will be asked to pay a fee at the time of your visit which will vary depending on the service received, your insurance co-pay, sliding fee eligibility and the outcome of your appointment. Payment can be made by: Cash . Credit card or debit card Personal check for the date of service.
What if I dont have health insurance?At Little River Medical Center, we provide services to all and offer a sliding scale fee based on income and family size. This program reduces the cost of care for eligible patients without insurance or with large insurance deductibles. To learn more about the application process, see Sliding Fee Application.
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Using The Sc Medicaid Portal
While all options are viable, applying online certainly has unique perks. By using the SC Medicaid Portal, youll be able to see all of your free and affordable health coverage options, plus you can save your work and return to it later. This is important because the application requires a lot of paperwork and documentation that you may not have in front of you all at once. Plus, it takes a while to complete the application properly. It may be easier for you to spend a few minutes at a time working on it.
