During the 2020 regular session, the West Virginia Legislature passed Senate Bill 648 that amended the Code of West Virginia, by adding a new section, designated §9-5-12a, relating to providing dental coverage and limitations for adult Medicaid members. West Virginia Medicaid will coordinate with existing dental providers and interested new providers to promote the access and quality of dental care for adult Medicaid members.
Covered dental services for enrolled adults 21 years of age and older are divided into:
- Emergent procedures to treat fractures, reduce pain, or eliminate infection; and
- Diagnostic, preventative, and restorative services.
Prior authorization may be required for specific emergent services and when service limits are exceeded. These services do not count toward the member’s $1,000 limit.
Beginning January 1, 2021, services classified as diagnostic, preventative, and restorative in nature will require authorization prior to services being rendered and have a coverage limit of $1,000 per member per calendar year. Members are responsible for payment of service cost exceeding the $1,000 yearly limit. Remaining balances at the end of the year CANNOT be carried over to the following year. Services classified as cosmetic in nature are not covered. Please click here appendices to Chapter 505 Oral Health Services for specific code coverage. For more information, please click on the below memo.
West Virginia Medicaid Adult Dental Program Memo
For more information, please contact the Bureau for Medical Services (BMS) at 304-558-1700.