Updates to Dental Benefits for Medicaid and HARP Members

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Updates to Dental Benefits for Medicaid and HARP Members

02/20/2024

As of Jan. 31, 2024, EmblemHealth began covering crowns and root canals in certain circumstances for Medicaid and Health and Recovery Plan (HARP) members. In addition, replacement dentures and implants will only need a dentist’s recommendation to determine if they are necessary. 

The New York State Medicaid Program Dental Policy and Procedure Code Manual (Dental Manual) will be updated to reflect:

  • Changes to the clinical criteria for coverage of root canals, crowns, replacement dentures, and dental implants to allow for expanded coverage of previously limited dental services.
  • Revisions to the coverage policies for these dental services to expand coverage when medically necessary.
  • Revisions to the prosthodontics policy that removes limitations on replacement prosthodontics coverage.

 

JP 64661 02/2024

Provider Update