First of all, we ought to say, that MassHealth is the state’s Medicaid program, and covers 1.1 million adults. Massachusetts Medicaid (MassHealth) pays for health care for certain low and medium income people living in Massachusetts. MassHealth offers health-care benefits directly or by paying part or all of your health-insurance premiums.

But there’s controversial question of the program with dental care. While children are guaranteed full dental care under federal law, states are permitted to make their own decisions about dental benefits for adults.

Massachusetts previously offered adults comprehensive dental care, but in 2010 the benefits were severely cut. Over the past years, advocacy has resulted in benefits being restored on a piecemeal basis.

Restoring periodontal care is major step forward in improving both oral health and general health. Periodontal (gum) disease is an infection of the tissues that hold your teeth in place. It's typically caused by poor brushing and flossing habits that allow plaque—a sticky film of bacteria—to build up on the teeth and harden. In advanced stages, periodontal disease can lead to sore, bleeding gums, painful chewing problems. When left untreated, this disease causes irreversible gum and bone loss, leading even to tooth loss. It also directly impacts chronic disease outcomes including those of diabetes, heart disease. So the decision to restore MassHealth coverage of periodontal treatment for adults is a major progress.

According to the MassHealth dental services regulations, the program provide coverage for periodontal services including gingivectomies, gingivoplasties, periodontal scaling and root planing for members aged 21 and older with prior authorization. These changes are effective April 22, 2019.

There are several nuances that you should consider. The MassHealth agency pays for periodontal scaling and root planing once per member per quadrant every three calendar years. The MassHealth agency does not pay separately for prophylaxis provided on the same day as periodontal scaling and root planing or on the same day as a gingivectomy or a gingivoplasty. The MassHealth agency pays only for periodontal scaling and root planing for a maximum of two quadrants on the same date of service in an office setting. Periodontal scaling and root planing involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus. It is indicated for members with active periodontal disease. Root planing is the definitive procedure for the removal of rough cementum and dentin, and/or permeated by calculus or contaminated with toxins or microorganisms. Some soft tissue removal occurs. Local anesthesia is considered an integral part of periodontal procedures and may not be billed separately. Prior authorization is required for members 21 years of age or older.

We ought to mention that dental providers and health organizations has been working on improving oral health in Massachusetts, including a focus on restoring adult dental benefits. At Aleris Salem Dental Center we always glad to help you with all questions about dental care. Please feel free to contact our professional team online or at our office phone 855-745-00-55!

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