• This is a DVHA custom measure that is based on the specifications for the Healthcare Effectiveness & Data Information Set (HEDIS®) child dental visit administrative measure.
• The annual reported rate captures activity during the stated measurement year (MY).
• There is no benchmark available for this custom measure.

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.

This measure looks at the percentage of Medicaid beneficiaries ages 21 and older who had any dental visit during the past year. It is a DVHA custom measure that follows the HEDIS any dental visit specifications for children. Regular visits to the dentist provide access to cleaning, early diagnosis and treatment, as well as education on how to prevent problems.

The Agency of Human Services (AHS) made the following changes to the Medicaid adult dental benefit effective January 1, 2020.

• Increasing the annual maximum dollar limit on adult dental services from $510 to $1,000.
• Allowing up to two visits for preventive services per calendar year that do not count towards the $1000 annual maximum dollar limit.
• Removing copayments from preventive dental services.

The changes are intended to expand adult Medicaid beneficiaries’ access to dental care and encourage the utilization of preventive dental care. These changes apply to Medicaid beneficiaries age 21 and older, who are not pregnant or in the postpartum period.

AHS is also removing the prior authorization requirements for periodic prophylaxis to allow more than two cleanings per year without prior authorization when medically necessary. This prior authorization change applies to all Medicaid beneficiaries.

Increases in eligibility stemming from pandemic-related policies resulted in increased Medicaid membership and thus a larger denominator for this measure in 2021 and 2022.  Even though the number of adults with an annual visit increased by several thousand compared to prior years, the rate went down slightly due to a higher percentage base.   

Last updated: April 2024

• Medicaid beneficiaries
• Dentists
• Vermont Department of Health - Office of Oral Health