Medicaid and Medicare

CMS offers tips on complying with Medicaid

A new resource from the Centers for Medicare & Medicaid Services gives dentists tips on how to properly comply with Medicaid and helps prepare them for potential dental audits.
The Medicaid Compliance for the Dental Professional materials show dentists how they can protect their patients and their practices by implementing an effective compliance program.

The information includes how to ensure accurate Medicaid claims are submitted; identify and correct issues before they become big problems; and take steps to place a dental practice in a better position to comply with the forthcoming compliance program requirements and oversight by regulatory agencies.

The toolkit can also help explain how to document medical necessity for dental procedures and understand where to report suspected issues of fraud, waste and abuse.

Access the Medicaid Compliance for the Dental Professional toolkit here.

The ADA offers its own resources on Medicare on the Center for Professional Success website,

It includes information on how dentists can opt in or out of Medicare and frequently asked questions about the program.

To read ADA News coverage on opting in or out of Medicare, visit and search for “ADA Offers Q&A Primer on Opting In or Out of Medicare” and “Dentists Must Choose to Opt In or Out of Medicare Enrollment.”


Recent Updates to Medicaid/Medicare

HIP 2.0 (waiting federal approval)
The Affordable Care Act allows States to expand Medicaid which is a program funded by the federal and state government, but administrated by the states. Expanding Medicaid is not a mandate however the federal government will penalize states that do not expand Medicaid. For example, hospitals will receive reduced reimbursement.
In response to this opportunity, Governor Pence is seeking the federal government’s approval of Indiana’s Healthy Indiana Plan (HIP) 2.0. It adds a consumer-driven component that is not part of most states’ Medicaid programs.  A current version of HIP is already in place which is only a medical plan. HIP 2.0 will have a Basic Plan and a Plus Plan.  The HIP Plus will allow participants to obtain dental coverage.  The dental benefits are not defined at this time. HIP Plus would be administered by the medical plans, which subcontracts with a dental benefit manager. The IDA has objected to bringing in a third party company and would prefer for the State to administer the plan itself. If HIP 2.0 is approved, we will advocate to make the plan functional and realistic and encourage participation by as many dental providers as possible. The State is planning to have HIP 2.0 in place by January 1, 2015 pending federal approval.
The HIP 2.0 providers have to be enrolled in both the Medicaid program (IHCP) and the dental plan administered by the medical plans. Currently there are three medical plans administering the HIP (Anthem, MDwise, and MHS).
The State is estimating that 350,000 individuals will be enrolled in HIP 2.0 that are currently uninsured.  Another 100,000 individuals (healthy adults from the existing Medicaid program) are going to be moved to HIP 2.0.
Hoosier Care Connect:
This program will move 88,000 from the healthy aged, blind, and disabled population from Hoosier Healthwise. They will have a similar type of plan to HIP 2.0 with expanded benefits to comply with federal regulations. There were 12-14 medical plans that sent in contract proposals. The State generally awards contracts in 30 days. This program would start April 1, 2015. The four patient populations that will be part of Hoosier Care Connect are:
  • Blind individuals (MA B)
  • Disabled individuals (MA D)
  • Individuals receiving Supplemental Security Income (SSI) (MASI)
  • M.E.D. Works enrollees (MADW, MADI)
The dental profession is actively engaging in continued discussions over the administration of the dental benefit with the State.

Many dentists have inquired about ADA articles encouraging them to officially “opt in” or “opt out” of Medicare. Very few dental procedures are covered by Medicare, so it’s understandable that dentists would ask, “What difference does it make?” The issue relates to a provision in the Affordable Care Act that requires providers to opt in, or opt out. Otherwise, Medicare will not pay for prescriptions the dentist writes for patients who have Medicare Part D prescription drug coverage.
The ADA is advocating to get dentists exempt from this opt in or out requirement, but unless the rules change the new policy will go into effect on June 1, 2015. There are several articles on the ADA website, including a Q&A primer to help you decide what you need to do. For information on how to opt in or out, go to


Additional information, including links for enrolling as a Medicaid provider, updates on the IDA Medicaid Task Force, the IDA response to RFP 15-001 and more is available in the IDA Member Center.

Please Log Into the IDA Member Center for more information on Medicaid.R

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