Michigan Medicaid Dental Corner

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A: Check eligibility in CHAMPS to confirm the patient is active and determine how they receive dental benefits, this drives billing and coverage requirements.  

• Fee-for-Service (FFS): Follow MDHHS billing and coverage guidelines 
• Medicaid Health Plan (MHP): Follow plan-specific network and billing processes 
• Healthy Kids Dental (HKD): For patients under 21

Quick tips: Verify eligibility day-of, confirm FFS vs. MHP vs. HKD, and check network participation when applicable. 

A: If you’re considering Medicaid participation (or trying to make it smoother for your team), two questions come up fast: “What does Medicaid pay?” and “What’s covered?” Michigan’s Dental Fee Schedule is the best place to start, it lists procedure codes and the associated fee screens (payment amounts). One important note: the fee schedule is about payment, and it doesn’t automatically mean a service is covered in every situation. For coverage details (documentation, billing indicators, limits), MDHHS points providers to the Medicaid Code and Rate Reference tool, which is accessed inside CHAMPS.  

A second helpful step is confirming how the patient receives dental benefits: some patients are Fee-for-Service, while many who are 21 years and older are enrolled in a Medicaid Health Plan (MHP). If a patient is in an MHP, you may also need to follow that plan’s dental network processes and guidance. MDHHS maintains a hub for Medicaid Health Plan information (including county coverage resources). Dental services for Healthy Kids Dental beneficiaries under 21 years of age will be provided by Healthy Kids Dental (HKD). 

Checklist (bookmark these): 

• Check payment amounts: MDHHS Dental Fee Schedule  
• Check coverage rules/limits: Michigan Medicaid Provider Manual (see the dental chapter)  
• Need code-specific details (billing indicators/documentation): Use the Medicaid Code and Rate Reference tool in CHAMPS  
• If a patient is in a Medicaid Health Plan: Use MDHHS Medicaid Health Plan resources (Michigan Medicaid Health Plan Listed by County) 
• If a patient is in Healthy Kids Dental (HKD): More information can be found at the following website Healthy Kids Dental Program

A: To see patients with Michigan Medicaid, your first step is enrolling in CHAMPS (Community Health Automated Medicaid Processing System)—Michigan’s online system used for provider enrollment and claims. Some providers also choose to see patients whose dental coverage is managed through a Medicaid Health Plan (MHP) (a health plan that administers Medicaid benefits for many enrollees). If that applies to your practice, there may be an additional step to connect with the plan(s) serving your county. 

Want the official step-by-step details and resources? 

Visit the Michigan Department of Health and Human Services’ Medicaid Dental provider page: https://www.michigan.gov/mdhhs/assistance-programs/medicaid 

Quick Glossary and Links: 

• CHAMPS: Community Health Automated Medicaid Processing System — Michigan’s online system for provider enrollment and claims. 
• MILogin: Michigan’s login portal used to access CHAMPS 
• SIGMA: The State of Michigan vendor system used for payments for some provider types. 
• MHP: Medicaid Health Plan — a health plan that administers Medicaid benefits for many enrollees.