RD561 - Smiles For Children: 11 Years of Excellence

Executive Summary:
Implemented on July 1, 2005, Smiles For Children (SFC) is the Virginia Medicaid dental program that was designed to improve access to high quality dental services for children enrolled in Medicaid and CHIP across the Commonwealth. The program was made possible through the support of the Governor and the General Assembly, including the provision of an overall 30 percent increase in Medicaid funding for the reimbursement of dental services. The program celebrated its eleventh year anniversary in 2016, and substantial evidence continues to demonstrate that Smiles For Children is achieving its goals and continues to serve as a model dental program among Medicaid programs.

Smiles For Children operates as a fee-for-service dental health benefit plan with a single benefits administrator, DentaQuest. The Department of Medical Assistance Services (DMAS) retains policymaking authority and closely monitors contractor activities. The Dental Advisory Committee (see Attachment A for a list of current Committee members), continues to assist DMAS in professional dental discussions. More than 922,000 Medicaid and CHIP members (approximately 621,000 children) are now eligible for the program. Medicaid and FAMIS cover comprehensive dental benefits for children under age 21 including: diagnostic, preventive, periodontal, restorative/surgical procedures, and orthodontics. Comprehensive dental benefits are not covered for adults under SFC. Medically necessary oral surgery and associated diagnostics are the only covered services for adults, with the exception of pregnant women, under the Virginia Medicaid dental program. Dental emergencies that may qualify for reimbursement are issues compromising a patient’s general health and such conditions must be documented by the dentist or medical provider. Effective March 1, 2015, as a component of Governor Terry McAuliffe’s A Healthy Virginia, the Smiles For Children program began providing comprehensive dental care, excluding orthodontia, to pregnant women enrolled in Medicaid and FAMIS MOMS.