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SCHIP Dental Coverage


Dental services for the State Children's Health Insurance Program (SCHIP)  are an optional benefit under Title XXI of the Social Security Act for all children up to age 19.  However, all States have opted to provide coverage for dental services.  Under Title XXI, States have flexibility in targeting eligible uninsured children. States may choose to expand their Medicaid programs, design separate child health programs, or create a combination of both.  States choosing to create a separate child health program may offer one of four benefit options:  State may elect to provide benchmark coverage; benchmark equivalent coverage; existing coverage that is substantially equal to coverage under the Federal Employees Health Benefit Plan, the State employee plan or a health maintenance organization that has the largest, uninsured commercial non-Medicaid enrollment in the State.  Benchmark equivalent coverage is coverage that, in the determination of the Secretary of Health and Human Services, provides appropriate coverage for the State Children's Health Insurance Program (SCHIP) children.  

Patient out-of-pocket costs for this program are allowed but limited.  If a State expands its Medicaid program, then existing Medicaid cost-sharing limits apply.  For all SCHIP enrollees, cost sharing cannot be charged for well-child and well-baby visits.  This includes routine preventive and diagnostic dental services (such as oral examinations, prophylaxis and topical fluoride applications, sealants and x-rays) as described in the most recent guidelines issued by the American Academy of Pediatric Dentistry.  In addition, States cannot impose cost-sharing charges that, in the aggregate, exceed five percent of a family's total income for the length of child's eligibility period in the State.

States may also use Title XXI funds for oral health services initiatives.  For example, California has opted to increase dental service utilization among low-income, uninsured children ages birth to five years by creating a health service initiative.  California's oral health service initiative includes case management, oral health education, innovative preventive services and mobile vans that will provide dental services.


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Page Last Modified: 12/10/2008 12:59:23 PM
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