Medicaid (MO HealthNet)

Beginning July 1, 2022 Missouri Medicaid (MO HealthNet) increased several dental rates approximately 120%. Now, dentists can help change the dental health and lives of this vast population and actually earn a living!

Give kids a dental home, treat kids so they won’t lose a tooth before graduation. Treat pregnant mothers so their periodontal disease won’t compromise their pregnancy. Treat adults so they won’t have to deal with dentures as they age. Make a difference in the lives of people in YOUR community: sign up to be a Medicaid provider. You can make it a small or large part of your practice!

There is a very large sector of Missouri’s citizens that are in dire need of dental care and depend on Medicaid coverage for all healthcare, including dental care. 

• Dental health for Missouri citizens at or below the federal poverty level declines rapidly with age. More than 13% have lost one permanent tooth by high school graduation; 42% of citizens age 65 or older and at or below the poverty level have lost all their teeth.
• There are many contributing factors however; we have identified a couple reasons for these findings:
  • Medicaid rates were extremely low which, made it difficult for a practice to absorb the cost of accepting Medicaid participants.
  • Many providers were under the assumption that adults did not have a Dental benefit through the Medicaid program. In 2016, Missouri Medicaid made significant strides in access to care by offering a Limited Adult Dental benefit to adults who previously wouldn’t have qualified for services.

• Approximately 12.7%of all Missourians (785,000 people) live in families with incomes below the federal poverty level.
• For example, that a family of 4 (2 adults and 2 children) would earn less than $27,479 a year. In that family there is no extra money after providing for the bare necessities.
• For approximately 1 out of every 8 Missourians any medical and dental care received is through Medicaid eligibility.

• Helps the most vulnerable in your community. Medicaid patients are: single parents, foster kids, low income adults (working poor), blind, disabled.
• With the fee increase, you are still able to provide care without a financial loss.
• You are able to “give back” to your community.
• You are able to provide preventive care to children and give them a “dental home”.
• You do not have to provide care to everyone, you can limit the number of patients you decide to care for.
• You can help your local hospital by keeping non-traumatic dental pain patients out of the Emergency Room.
• You can set an example to your dental community that you are willing to care for the underserved.
• Many patients have to travel long distances and have long waits for care, you can help to alleviate this tragic situation.

• If you are planning on opening your own practice, this is a great way to have a reliable source of patients.
• You could devote one day or a portion of a day per week to patients with Medicaid.
• You don’t have to worry about collections.
• You don’t have to “sell” dentistry.
• You can treatment plan what is best for your patient.
• There is no minimum to what can be spent in a calendar year.
• Cost is not prohibitive to accept treatment.

MO HealthNet 101 Presentation

This presentation provides a quick overview of the following:

• What is MO HealthNet
• Eligibility: Who qualifies for MO HealthNet 
• Coverage/Benefits: Types of MO HealthNet coverage (Managed Care vs Fee For Service)
• Reasons to Accept Medicaid
• Enrollment: Missouri Medicaid Audit and Compliance and Managed Care
• MO HealthNet Resources and Contact Information

Dental providers are encouraged to sign up for MO HealthNet News to receive emails directly from MO HealthNet (all bulletins, Hot Tips and other emails are sent through this distribution list). Providers will receive information about ALL MO HealthNet programs, but notifications will clearly state the program (such as dental) impacted by the change or update. Signup by visiting the website and completing the pop-up request OR provide your email under Email Updates on the right side of the page. Additional resources can be found on the MO HealthNet Provider page.

Jessica Emmerich, Dental Medicaid Facilitator
Missouri Coalition for Oral Health
573-536-2474 or Email

Jessica Emmerich is new to this position as Dental Medicaid Facilitator with MCOH, although prior she has worked with MCOH as its Operations Manager. In this role she will work closely with MO HealthNet and MDA to support dental practices in becoming and staying MO HealthNet providers. This is a grant funded position in which MCOH is working collaboratively with MDA and MO HealthNet to support greater provider participation and increased access to dental care throughout the state. This project is possible through the generous support of the Missouri Foundation for Health.  

Amanda Fahrendorf
MO HealthNet Education and Training Unit
573-751-0352 or Email

Amanda Fahrendorf is the Lead Education & Training Specialist located in the Department of Social Services (DSS), MO HealthNet Division (MHD), Education and Training Unit. During her 21 years of tenure with DSS, Amanda has built strong relationships with providers to streamline processes to serve our providers
and participants. She provides training and interpretation of MHD policy, program limitations and benefits and can answer questions about proper billing procedures, the eMOMED system, patient benefits and more.

Find recent Focus MDA magazine Medicaid Information Series articles, as well as other updates and resources. Click for news.

• Training Information/Resources
• Provider Training Calendar (find/register for Dental sessions)  

• Provider Bulletins:  
  • CBCT Codes, November 2
  • Rate Update for Dental Services, July 29
• Provider Hot Tips: See Index for program-specific
  • Dental Program, July 8
• Dental Provider Manual: See sections 13/14/15/19 for dental specific
• MO HealthNet Fee Schedule: With Current Rate Update for Dental Services
• Dental Policies & Billing Resources
• Provider Resource Guide: Provides definitions for each ME code. Each person determined eligible for MO HealthNet is assigned a Medical Eligibility (ME) code, which drive most MO HealthNet benefits.
• eMOMED: Check patient eligibility.
• Dental Benefit Table: Breaks down which coverage an individual is eligible for based on their assigned ME code. 

Participants can be enrolled in a FFS or MC plan based on how they qualify for MO HealthNet (Missouri Medicaid). Providers will need to follow the billing, policy and prior-authorization guidelines of the plan the participant is enrolled in. Providers must bill MO HealthNet directly for FFS participants and the MC plan for patients enrolled in MC.

• Read Medicaid Information Series: Part 2 (Understanding what benefits are available to MO HealthNet participants) for more about the differences between FFS and MC plans. 
• MO HealthNet Fee-For-Service (FFS) participants: Individuals with disabilities, seniors, blind and visually impaired, or women with breast or cervical cancer.
• Missouri Managed Care (MC) participants: MO HealthNet for Families, MO HealthNet for Kids, MO HealthNet for Pregnant Women, Uninsured Women, Transitional MO HealthNet, children in care and custody of the state, children receiving adoption subsidy and Children’s Health Insurance Program (CHIP). Click here for General MO HealthNet Managed Care information. Following are the four Managed Care health plans and their dental subcontractors: 

Managed Care Plan	Dental Contractor
Healthy Blue 833-388-1407 Home State Health 855-694-4663 UnitedHealthcare 866-292-0359	DentaQuest 800-417-7140  Envolve 855-434-9240  Envolve 855-434-9240
A sub plan administered by Home State Health is Show Me Healthy Kids (877-236-1020), specifically for instances of state custody, adoption subsidies and foster care

All providers who want to treat MO HealthNet FFS or MC participants must first enroll with Missouri Medicaid Audit and Compliance (MMAC), which facilitates the MO HealthNet enrollment process.

• Read Medicaid Information Series: Part 1 (There’s a rate increase, now what? Getting started as a Dental Medicaid provider) for more about becoming a provider. 
• First thoroughly review the Provider Enrollment Guide which contains detailed information and instructions regarding the provider enrollment process.
• Then complete the Provider Enrollment Application. 

Once the provider enrolls with MO HealthNet through MMAC, they will need to contact the MC plan they want to credential with. Each plan has its own credentialing process.

Those who participate in the MO HealthNet program agree to accept the MO HealthNet payment as reimbursement in full for all covered services. A participant cannot be billed for the difference between the MO HealthNet and the provider's billed charges.

MO HealthNet MC services are provided in accordance with the terms and conditions of the contract between MO HealthNet and the MC health plans. Participants enrolled in MO HealthNet MC plans access services through the health plan's provider network.

Questions regarding MMAC’s enrollment process may be sent to MMAC.providerenrollment@dss.mo.gov.