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

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.

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Florida Dental Access Guide