Dentures are a type of dental prosthesis that can be covered by the expanded dental benefit for adults described in chapter 505 of Appendix C of the West Virginia Medical Card. This benefit is subject to certain restrictions, such as the cost of the dentures, which may limit other services that a member would have access to, unless they are willing to pay for them out of pocket. The West Virginia Children's Health Insurance Program (WVCHIP) is a health insurance program for children under 19 years of age of working parents who don't qualify for Medicaid. To be eligible for this service, you must first get approved by your Medicaid plan.
Medicaid is partially funded by the federal government, but each state can customize plans according to local needs. In West Virginia, Senate Bill 648 was passed in order to expand coverage for more than 300,000 adult Medicaid beneficiaries in the state who were only eligible for emergency dental procedures. This expansion allowed people who lived up to 138% of the federal poverty level to have access to Medicaid (158% for pregnant women and 300% for children). The Health Home team can help you manage your medications, remember your appointments, read and understand the results of your medical tests, help you find transportation to and from medical appointments, and work with medical specialists or help you find in your area.
This allows people who are employed and earn too much to qualify for Medicaid, but who don't yet earn enough to cover health care. Dual-eligible special needs plans (DSNP) are a form of Medicare Advantage that offer additional benefits such as dental, vision, hearing and more to those who qualify. It is a behavioral health home that focuses on bipolar Medicaid beneficiaries in West Virginia who are at high risk of developing hepatitis B or C. There is also a Medicaid employment incentive for people between 16 and 65 years old who are disabled and working.
You'll also find information about prior authorization, which means that there are certain drugs that you'll need Medicaid to approve before you pick up your prescription according to the Medicaid rate. The non-emergency benefit is available to Medicaid beneficiaries who don't have reliable transportation and need help getting to and from multiple doctor appointments (and, in some cases, at pharmacies). West Virginia Medicaid will coordinate with existing dental providers and with interested new providers to promote access and quality of dental care for adult Medicaid members. WV Citizen Action was part of the Health Care for All WV coalition team that lobbied for this breakthrough.
Most people who have Medicaid in West Virginia will have to choose an MCO, with exceptions for some elderly and disabled people, those with Medicaid and Medicare, adoptive children and those who qualify based on their high medical expenses.
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