Honolulu Dental Providers Info

For the first time in ten years, DHS has resumed dental benefits for adults who have Medicaid and is called PADD, the Prevent Adult Dental Decay program. For a decade Medicaid covered emergency extractions only for adults has now been changed to include $500 a year dental benefit. On page four of the Quest Hawai'i pamphlet, revised 2.14.2007, it states, "two additional adult benefits; adult preventive and restorative dental benefits with a $500 limit."

Although this change is an improvement over extractions only, a single root canal on a back molar is $900 - $1200 UCR, the usual and customary rate. Hawai'i state would save money in the long run if fixed all the problems in one year, instead of waiting another year to pass, allowing the tooth infection to fester and become more expensive to heal later.

An exception to the general exclusion is given by Medicaid if the patient has low immunity against infections. According to the institute of Medicine in "Extending Medicare Coverage for Preventive and Other Services, "Oral infection ... increase systemic morbidity in patients who are immunocompromised." ^[1]

The report on Act 160, Section 4. (43), Section 39.1 states that the Hawai'i Pre-Paid Management Information System expects Medicaid patients who have had zero dental care for ten years will have a higher number of emergent dental needs that coverage should be interpreted correspondingly. The report ends with, "... basic preventive and restorative dental benefits for Medicaid adults will improve their health and self-sufficiency as well as save the State cost in the long run." ^[2] "A filling today is cheaper than a root canal a year from now." ^[3]

Any dental work above and beyond the $500 limit that is medically necessary must be preauthorized for the exception to the exclusion by having the patient's primary doctor write a general note advocating an specific dental procedure for the patient. The dentist's office then fills out a request for dental authorization which takes time for Medicare approval.