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

HIP Medicaid, Family Health Plus and Child Health Plus member coverage includes comprehensive preventive and specialty dental services. Dental coverage includes the following services*:

  • Routine exams.
  • X-rays.
  • Cleanings, fillings and tooth pulling.
  • Emergency treatment.
  • Replacement of missing teeth (full and partial dentures when conditions meet Medicaid coverage guidelines.)
  • Root canals on a case by case basis when conditions meet Medicaid coverage guidelines
  • 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 not covered.
  • Orthodontic services are not covered by HIP, but are covered by general Medicaid in certain circumstances. HIP network dentists will refer children under 21 years of age who meet Physically Handicapped Childrenís program guide to Medicaid approved orthodontists for evaluation. The result of the evaluation will determine coverage for these services.

*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.

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

In addition to using a HIP network dentist, Medicaid and FHPlus members may also get HIP covered dental services from a dental clinic operated by an academic dental center.

Dental Provider Search

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 Monday through Thursday from 8 am and 8 pm, and on 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 dentistís judgment in each individual case based upon a multitude of factors.

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

Last Modified 2/1/2010.
Certain benefit changes required by health reform may or may not apply to you, depending on your plan. Get more info.