HIP Medicaid/Family Health Plus/Child Health Plus Dental Benefits Program

Click Here To Search For Dental Providers

Dental Services

Coverage Includes

You may get the following services from a HIP network dentist or self-refer to a dental clinic operated by an academic dental center or the New York City Department of Health and Mental Hygiene:

• Routine exams.
• X-rays.
• Cleanings, fillings and tooth pulling.
• Emergency treatment.
• Replacement of missing teeth (full and partial dentures). Covered when conditions meet Medicaid guidelines.
• Root canals. Patients must be evaluated on a case by case basis to determine if conditions meet Medicaid coverage guidelines. Coverage will generally be provided when the number of teeth needing or likely to need root canals is “not excessive” the patient has good oral hygiene, and a healthy mouth and gums, and:
  • Has few if any cavities; and
  • Has a full complement of natural teeth: and
  • Has had all other necessary restorations completed; and/or
  • Is undergoing orthodontic treatment.

Coverage Does Not Include

• Root canals will not be covered when the prognosis of the tooth is questionable or extraction and replacement is a reasonable alternative course of treatment. Molar root canals will not be covered for patients over the age of 21 except where the tooth is a critical abutment for an existing prosthesis.
• Crowns will not routinely be approved if restorative materials can restore the teeth. Crowns will not be covered on molar teeth for patients over the age of 21.
• Fixed bridges are considered beyond the scope of the program and not covered.

HIP does not cover orthodontic services. However, Medicaid does cover these services in certain circumstances. HIP network dentists will refer children under 21 years of age that appear to meet Physically Handicapped Children’s Program criteria to a Medicaid approved orthodontist for an evaluation. The result of the evaluation will determine coverage for these services.

For More Information

You may refer to the Benefits section of this web site for more detailed coverage information. Medicaid and Family Health Plus members may also refer to their HIP Member Handbook. CHPlus members may also refer to their Subscriber Contract.

Dental Providers

Dental services are provided by Healthplex Inc., a dental management organization through its network of participating dentists. Each HIP Medicaid, Family Health Plus and Child Health Plus member is automatically assigned to a HIP participating dentist in the Healthplex network upon enrollment. Members are generally assigned to the participating dentist closest to where the member lives. The name, address and telephone number of the assigned dentist is provided in the New Member Welcome Kit.

HIP New York City Medicaid members (not Family Health Plus or Child Health Plus members) may also get covered dental services at New York City Department of Health and Mental Hygiene facilities. When you choose one of these dental providers, no referral or prior approval is needed. Just call and schedule an appointment.

Dental Provider Search

Customer Service

If you have questions about your dental coverage or would like to change your HIP network dentist, call Healthplex at 1-800-468-9868 between 8 am and 8 pm, Monday through Thursday and Friday from 8 am to 6 pm.

Important Notes

This benefit only applies to Medicaid, Family Health Plus and Child Health Plus members.

Participating dentists may recommend that members receive additional services and procedures consistent with generally accepted dental practices. For example, a recent full mouth series of x-rays is required at the time of examination. Frequency of x-rays depends on your dentist's judgment in each individual case based upon a multitude of factors.

An examination and x-rays are required prior to a cleaning.