Amendments to Virginia Budget Include Changes to Dental Medicaid Benefit

The Virginia General Assembly convenes this week in a special session to approve amendments to the biennial budget. Among the amendments are changes to the dental Medicaid benefit, which, if approved, will be effective January 1, 2024. 

Effective January 1, 2024, the Department of Medical Assistance Services is authorized to amend the State Plan for Medical Assistance Services to: 

(i) extend the age limitation for children receiving fluoride varnish from non-dental providers from "through age 3" to "through age 5"; 

(ii) remove the current limitation on the number of times a dentist can bill the behavioral management code when treating adults with disabilities; 

(iii) provide payment for crowns for patients who received root canal therapy prior to becoming a Medicaid beneficiary; and 

(iv) provide reimbursement for pre-treatment evaluations performed by dentists treating patients requiring deep sedation or general anesthesia to mirror the Centers for Medicare and Medicaid Services (CMS) guidelines. 

The department shall have the authority to implement these changes consistent with the effective date in the State Plan amendment approved by CMS and prior to the completion of any regulatory process undertaken in order to effect such change.

Learn more about Virginia’s dental Medicaid benefit at https://www.dmas.virginia.gov/for-providers/dental/for-dentists/