Florida Dental Access Guide

Florida Medicaid – Covered Dental Services for Adults

The following tables list the dental services that are covered by Florida Medicaid’s dental plans.

Important Things to Remember:

  • You may need a referral from your doctor, dentist, or approval from your dental plan before you go to an appointment or use a service.
  • Services must be medically necessary in order for your plan to pay for them.
  • You may have a $3.00 copayment per day for a non-emergency dental visit in a federally qualified health center.
    If there are changes in covered services or other changes that will affect you, the plan will notify you in writing at least 30 days before the effective date of the change.
  • It is strongly recommended that you call ahead to member services to confirm the services before your appointment.
Member services:

DentaQuest
1-888-468-5509
TTY 1-800-466-7566
Member Handbook

MCNA Denta
1-855-699-6262
TTY 1-800-955-8771
Member Handbook

LIBERTY
1-833-276-0850
TTY 1-877-855-8039
Member Handbook

Your Plan Dental Benefits
Service
Description
Frequency/specific limitation
Prior Authorization
Dental Exams
A review of your tooth, teeth, or mouth by a dentist
– Complete exams for dentures are covered 1 time every 3 years
– Emergency exams are covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Dental X-rays
Internal pictures of teeth with different views
Only some types of dental x-rays are covered:
– 1 full mouth set of x-rays every 3 years
– 1 view of the whole mouth (panoramic) x-ray every 3 years
– Other single tooth x-rays as needed
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Prosthodontics
Dentures or other types of objects to replace teeth
– 1 upper, 1 lower, or 1 set of full dentures
– 1 upper, 1 lower, or 1 set of partial dentures
– 1 improvement for denture fit and comfort (reline) for each denture every year
DentaQuest:
No
MCNA Dental:
Ask for approval before you go to an appointment for these services
LIBERTY:
Ask for approval before you go to an appointment for these services
Extractions
Tooth removal
Covered as medically necessary
DentaQuest:
No
MCNA Dental:
Ask for approval before you go to an appointment for these services
LIBERTY:
Ask for approval before you go to an appointment for these services
Sedation
A way to provide dental services where a patient is asleep or partially asleep
Covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Ambulatory Surgical Center or Hospital-based Dental Services
Dental services that cannot be done in a dentist office. These are services that need to be provided with different equipment and possibly different providers
Covered as medically necessary for any dental services needed
DentaQuest:
No
MCNA Dental:
Ask for approval before you go to an appointment for these services
LIBERTY:
Ask for approval before you go to an appointment for these services

Who is Eligible for Medicaid?

To qualify for Florida Medicaid, individuals have to be within certain income limits. These limits are based on the federal poverty level (FPL) and vary depending on age and household size. 

  • Children up to 1-year-old: 200% of the federal poverty level (FPL)
  • Children ages 1-18: 133% of FPL
  • Children under age 19 can qualify for Florida Healthy Kids, with modest monthly premiums, if household income is between 133% and 200% of FPL.
  • Pregnant women: 196% of FPL Adults with minor children: 26% of FPL
  • Individuals who qualify for Supplemental Security Income (SSI) automatically qualify for Medicaid in Florida.

Prior Authorization:

Prior authorization is a process by which a medical provider (or the patient, in some scenarios) must obtain approval from a patient’s health plan before moving ahead with a particular treatment, procedure, or medication. Different health plans have different rules in terms of when prior authorization is required.

Medically Necessary:

The medical or allied care, goods, or services furnished or ordered must meet the following conditions:
  • Be necessary to protect life, prevent significant illness or significant disability, or alleviate severe pain.
  • Be individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the patient’s needs
  • Be consistent with generally accepted professional medical standards as determined by the Medicaid program, and not experimental or investigational.
  • Be reflective of the level of service that can be safely furnished, and for which no equally effective and more conservative or less costly treatment is available statewide.
  • Be furnished in a manner not primarily intended for the convenience of the recipient, the recipient's caretaker, or the provider.
The fact that a provider has prescribed, recommended, or approved medical or allied care, goods or services does not, in itself, make such care, goods, or services medically necessary or a medical necessity or covered service.
Expanded Benefits

Each plan features “Expanded benefits” that are extra goods or services that should be provided to you, free of charge. 

Important Things to Remember:

  • Call Member Services to ask about getting expanded benefits. 
  • These extra services are provided to adults that are ages 21 years or older.
  • For pregnant women that are ages 21 years and older, more services may be available to help with a healthy pregnancy.
  • Services must be medically necessary in order for your plan to pay for them.
Service
Description
Frequency / limitation
Adults (ages 21+)
Frequency / limitation
Additional Services for Pregnant Adults (ages 21+)
Prior Authorization
Dental Exams
A review of your tooth, teeth, or mouth by a dentist
– Complete exams are covered 1 time every 3 years
– Check-up exams are covered 2 times every year
Additional dental exams covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Dental Screenings
A review of your mouth by a dental hygienist
Covered 2 times every year
Additional dental screenings are covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Dental X-rays
Internal pictures of teeth with different views
All types of dental x-rays are covered
Additional dental x-rays are covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Teeth Cleanings
Basic cleanings that may include brushing, flossing, scrubbing, and polishing teeth
Covered 2 times every year
Additional dental cleanings are covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Fluoride
A medicine put on teeth to make them stronger
Covered 2 times every year
Additional fluoride is covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Sealants
Thin, plastic coatings painted into the grooves of adult chewing surface teeth to help prevent cavities
We cover sealants 1 time every 3 years for each adult chewing (back) tooth
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Oral Health Instructions
Education on how to brush, floss, and keep your teeth healthy
Covered 2 times every year
Additional oral health instructions are covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Fillings
A dental service to fix or repair teeth
Some fillings services are covered for front and back (chewing) teeth as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Periodontics
Deep cleanings that may involve both your teeth and gums
Covered as medically necessary
Additional general services are covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Extractions
Tooth removal
Covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
General Services
Dental consultations to visits a dentist for an opinion and dental pain treatment
Covered as medically necessary
Additional general services are covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Diabetic Testing
Dental office diabetes testing
Covered 1 time every year
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Dental Office Visits for Persons with Disabilities
A visit to the dental office to get comfortable with the office and the dentist before dental work is done.
Covered for persons with intellectual disabilities 1 times for every new dental office or dentists
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No

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The Florida Dental Access Guide is a project of the The Florida Oral Health Alliance.

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