Medicaid is one of PRDC’s most important programs. In fact, the majority of our patients utilize their benefits to keep their smiles healthy. PRDC can help you determine if you are eligible and work with your county Department of Social Services to help get you and yours signed up. Once enrolled it is important you update your eligibility every six months as required in order to keep your benefits active.
Adult Medicaid including Medallion and CCC+
Effective January 1, 2019 adults in Virginia with household incomes up to 138% of the federal poverty level are eligible for Medicaid. Medicaid covers dental extractions and related costs. HOWEVER, the Managed Care Organizations administering the program have added additional benefits such as comprehensive exams and cleanings. Some even offer money towards other dental care. If you wish to change Managed Care Organizations so you get different dental benefits, call the Managed Care Helpline at 1-800-643-2273 (TDD 1-800-817-6608). The helpline is available Monday through Friday from 8:30 am to 6:00 pm. (Medallian chart = illustration)
If you are disabled and have both Medicaid and Medicare (called CCC+) you also have additional benefits (CCC+ chart as graphic)
Cover Virginia is your best source for information if you are new to Medicaid. Their website is https://www.coverva.org/healthplans
Children enrolled in Virginia’s Smiles For Children program, the dental component of FAMIS, receive comprehensive dental care at no cost to their families. This can even include braces if they are medically necessary! Children enrolled in Virginia’s Smiles For Children program, the dental component of FAMIS, receive comprehensive dental care at no cost to their families. This can even include braces if they are medically necessary! Dental services for children enrolled in FAMIS or FAMIS Plus are provided through the Smiles For Children program. The Smiles For Children program encourages good dental health and recommends regular checkups with your child’s dentist. There are no costs or co-payments for dental care services in the Smiles For Children program. You should only use dental providers, like Piedmont Regional Dental Clinic, enrolled in the Smiles For Children network. To access services, use your child’s Commonwealth of Virginia (blue and white) plastic ID card or MCO member card each time you visit the dentist. The Smiles For Children program is managed by DentaQuest. All FAMIS and FAMIS Plus enrollees get a Smiles For Children member handbook. The member handbook explains your child’s dental benefits in more detail. A listing of all the Smiles For Children dental providers is also mailed to each enrolled family. For questions or to find a dentist in your area, call Smiles For Children at 1-888-912-3456. For information on how to apply, click here.
For Pregnant Women
Pregnant women are also eligible for comprehensive dental benefits on Medicaid! This is an exciting NEW benefit! To receive these benefits you must enroll in Medicaid Pregnant Women’s program through your county DSS. Once your baby is born, you will need to enroll your newborn for coverage as well. Dental services for pregnant women enrolled in Medicaid and FAMIS MOMS include: X-rays and examinations Cleanings Fillings Root canals Gum related treatment Crowns, bridges, partials and dentures Tooth extractions and other oral surgeries, and Other appropriate general services Orthodontic treatment is not included in the coverage. Click here Pregnant Women FAQs to learn more about Medicaid benefits for pregnant women or watch our video. For more information contact PRDC or your county Department of Social Services office.