Dental services for the Children's Health Insurance Program (CHIP) shall include coverage necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions for all children up to age 19 who are eligible for CHIP in a particular State.    

States choosing to create a separate child health program may offer one of four benefit options:  States may elect to provide benchmark dental coverage; benchmark dental benefit equivalent coverage; existing coverage that is substantially equal to coverage under the Federal Employees Health Benefit Plan dental coverage, the State employee dependant dental coverage, coverage offered through a commercial dental plan that has the largest insured commercial, non-Medicaid enrollment of dependent covered lives of such plans that is offered in the State involved.  Benchmark equivalent dental coverage is coverage that, in the determination of the Secretary of Health and Human Services, provides appropriate dental coverage for the Children's Health Insurance Program (CHIP) 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 CHIP 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, sealant 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.

States with a separate CHIP program also have the option to provide dental-only supplemental coverage for eligible children. 

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Page Last Modified: 03/31/2009 4:01:00 PM
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