MassHealth Fact Sheet – FY11 H.2
Adult Dental Coverage Restructuring

Overview 

In FY09, MassHealth spent $299 million on dental services, including $161 
million for services for children and $138 million for adult services.  Although 
FY10 is not complete, spending on dental services continues to increase. 

Dental coverage for adults is one of the optional services covered by 
MassHealth, meaning that this service is not a federally-required component of 
Medicaid coverage.  Utilization of dental services has rapidly increased, 
particularly for adults (39.7% from FY07 to FY09).  To restrain these cost 
increases, adult dental services are being restructured in House 2.  The net 
result of these changes in FY11 will be a $ 56 million savings in the MassHealth 
budget.   

FY11 Benefit Changes 

• Children will have no change in coverage.  
• Adults with intellectual disabilities who are enrolled because they have 
active cases with the Department of Developmental Services (DDS) will also have 
no change in coverage.  
	o Restorative dental services for these developmentally disabled adults 
will be state funded; federal matching funds will not be claimed for these 
services 

• Adult preventive and emergency services will continue to be covered. 
	o 	Examples of preventive and emergency services are: 
		. Diagnostic (exams, x-rays) 
		. Preventive (cleanings, fluoride) 
		. Extractions 
		. Emergency Care Visits 
		. Treatment of Complication – Surgery 
		. Anesthesia 
		. Professional Visit 

• Restorative dental services for adults will no longer be covered under 
MassHealth.  
	o 	Examples of restorative services are: 
		. Periodontic (gingivectomy, deep scaling) 
		. Restorative services (fillings)
		. Root Canals 
		. Crowns 
		. Dentures (full, partial, repairs) 


	o 	In many cases, MassHealth members will have access to these services 
at Community Health Centers through the Health Safety Net.