% of adults who meet their dental benefit cap
Notes on Methodology
The rates above represent the % of adult beneficiaries who met their dental benefit cap for that calendar year.
Numerator – Adults aged 21 and older with dental claims that reached the cap during the calendar year. In 2020 the cap was raised from $510 to $1,000 per calendar year.
Denominator – Adults aged 21 and older with any dental services during the calendar year.
Story Behind the Curve
Effective July 1, 2023, the reimbursement rates for Medicaid-covered dental services have been updated to 75% of regional commercial dental rates. This reimbursement methodology change represents an approximate 50% increase in reimbursement for dental services provided to Vermont Medicaid members. The adult annual cap on dental expenditures has increased to $1,500 to coincide with the updated rates, also effective July 1, 2023. Medicaid members under the age of 21, and those who are pregnant or in the 12-month postpartum eligibility period, are not subject to the adult annual cap for dental services.
In January of 2020, the adult annual cap on expenditures increased from $510-$1,000 per calendar year as a result of Act 72.
During 2020, dental offices were closed for several months due to the COVID-19 public health emergency. These changes led to a decline in the number of adults reaching the annual cap on expenditures.
Last updated: July 2023