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Evaluation of the Dental Wellness Plan 2.0: Member Experiences After Two Years

On May 1, 2014, the Centers for Medicaid and Medicare Services (CMS) approved Iowa’s request to amend the Iowa Wellness Plan to include a Dental Wellness Plan (DWP) component, which provided dental benefits to the ACA expansion population. DWP 1.0 provided dental benefits, via a three-level earned benefit structure, to the adult (age 19-64) expansion population based on completion of periodic dental exams every 6-12 months.

In July 2018, Iowa integrated its fee-for-service adult dental Medicaid program with the Iowa Dental Wellness Plan (DWP). The integrated adult dental program, DWP 2.0, provides comprehensive benefits to members during their first year of enrollment, and requires members to complete to healthy dental behaviors annually in order to avoid monthly premiums and maintain comprehensive benefits. Healthy dental behavior requirements include an oral health self-assessment and a preventive dental visit. If members do not complete both healthy dental behaviors each year and do not pay $3 monthly premiums, coverage is reduced to a limited set of benefits. Beginning in September 2018, a $1,000 annual benefit maximum was implemented for all adults in the DWP 2.0 program, except for the EPSDT population.

Reynolds, J., Ingleshwar, A., McKernan, S., McInroy, B., & Damiano, P. Evaluation of the Dental Wellness Plan 2.0: Member Experiences After Two Years. : University of Iowa Public Policy Center.