Medicaid Dental Services: New Hampshire Smiles Program for Adults
Information and resources for the Adult New Hampshire Smiles Program
NH DHHS selected Northeast Delta Dental, in partnership with DentaQuest, to provide dental services for the adult dental benefit. For help, call 1-844-583-6151, TTY 800-466-7566, Monday through Wednesday 8:00 A.M to 8:00 P.M., Thursday through Friday 8:00 A.M. to 5:00 P.M. EST. Customer Service agents are available to help with your benefit questions and dental care management needs. For help with transportation to adult dental services, contact Coordinated Transportation Services (CTS) at 1-844-304-6630. Information is available at no cost in other formats and languages.
Benefits Available for Medicaid-Eligible Adults Ages 21 and over
A. Covered services include:
- X-rays and examinations
- Cleanings
- Fillings
- Limited gum-related treatment
- Tooth extractions and other oral surgeries
- Other appropriate general services such as anesthesia
B. Removable partial and full dentures for individuals who qualify for services under the following criteria:
- Developmental Disability (DD) Waiver
- Acquired Brain Disorder (ABD) Waiver
- Choices for Independence (CFI) Waiver
- Nursing facility residents
C. $1500 yearly limit on dental services, with the exception of preventive services.
Cost Sharing
For individuals above 100% Federal Poverty Level (FPL), cost sharing is 10% of the fees for the services at each visit. Cost sharing is limited to 5% of household income. The exceptions are diagnostic and preventive services which do not have cost sharing. There are some individuals who are exempt from cost sharing, such as those members receiving services through the DD, ABD and CFI Waivers listed above. Individuals responsible for cost sharing will receive notification from DHHS.
Finding a Dentist
It is easy to find a dentist in your area. Go to DentaQuest.com/newhampshire. Select Find a Dentist and fill in the information such as your zip code, city or town. You can also search for a dental specialist. A list of NH Smiles Adult Medicaid dental providers and specialists in your area will be displayed. Review the list and call any of the listed providers to make an appointment.
Helpful Resources
DentaQuest Members
IMPORTANT NOTE: The Children’s Dental benefit remains in the Medicaid Fee for Service benefit for ages birth to 21.
NH Medicaid Adult Dental Benefit Effective April 1, 2023
With the signing of both HB 103 and SB 422 into law by Governor Sununu on July 1, 2022, the NH DHHS worked through the contracting process and selected Northeast Delta Dental, in partnership with DentaQuest, to provide dental services for the adult dental benefit. The implementation timeline is below:
A. RFI released by August 1, 2022: RFI-2023-DMS-01- MEDIC: Medicaid Care Management Dental Benefit
B. RFP released by September 1, 2022: RFP-2023-DMS-06-MEDIC: Medicaid Care Management Dental Benefit
C. Rules development and approval from September 2022 to January 2023 for adoption by April 1, 2023
D. Adult Dental Benefit Contract approved by Governor and Council in November 2022
E. Systems changes likely to be adopted by April 1, 2023
F. Contract implemented on April 1, 2023
G. State Plan Amendments submitted by June 30, 2023
State Plan and Waiver Materials for Adult Dental Benefit
Several waiver and state plan amendments are required by the Centers for Medicare and Medicaid Services (CMS) to implement the adult dental benefit.
- State Plan Attachment: 3.1-A Page 4a
- State Plan Attachment: 3.1-B Page 4a
- State Plan Attachment: 4.19-B Page 2a
- State Plan Attachment: 3.1-A Sufficiency Questions
- State Plan Attachment: Alternative Benefit Plan application
- State Plan Cost Sharing Requirements G1
- State Plan Cost Sharing Requirements G2a
- State Plan Cost Sharing Requirements G2b
- State Plan Cost Sharing Requirements G2c
- State Plan Cost Sharing Requirements G3
- 1915(c) ABD Removable Prosthodontic Services Amendment
- 1915(c) CFI Removable Prosthodontic Services Amendment
- 1915(c) DD Removable Prosthodontic Services Amendment
- 1915(c) Projected DD ABD CFI Waiver Amendment
- 1115 Dental Amendment Application
- 1115 Dental Amendment Budget Neutrality Template for DY 5 SFY 23
- 1115 Dental Amendment Budget Neutrality Template for Extension SFY 24-28
- 1915(b) Adult Dental Waiver Application
- 1915(b) Initial Waiver Cost Effectiveness
- 1915(b) Dental Cost Effectiveness Documentation