2898 Mahan Drive, Suite 1 Tallahassee, Florida 32308

Dental Program FAQ

Frequently Asked Questions About the Dental Program

What is the wait time for a determination regarding an Application?

Applications are processed in accordance with our Contract with the Agency for Persons with Disabilities. Hundreds of applications are received each month and it may take longer than 30 days for processing. Completing pages 1-4 of the Application which includes providing Signatures and attaching a Dental Treatment Plan from your Dentist (if you have one) will speed up processing.

What if I do not have a current Dentist?
Eligible Applicants without current Dentists will receive assistance from Dental Program Staff once the applications have been verified and processed. Staff will identify Program Network Dentists for selection in or near applicants’ homes.

What if there are no Program Network Dentists in or near my home?
Dental Program Staff will assist Eligible Applicants in identifying Program Network Dentists for selection in other areas or seek to recruit Dentists. Applicants’ willingness and ability to travel to other areas enables acquiring dental treatment.

Can I apply to the Dental Program if I have a Medicaid Managed Care Dental Plan and/or Dental Insurance to pay for treatment?

Yes. Applicants must first use benefits from Medicaid Managed Care Dental Plans and/or Dental Insurance before Arc of Florida Dental Program Funds can be accessed on their behalf. Services denied by Plans and/or Insurance may be funded by the program.

What if I need Sedation to complete Dental Treatment?
The Dental Program pays for all types of Sedation (Oral, Gas, IV, Deep, Hospital) and has Network Dentists that perform treatment under those types of Sedation.

What Services are FUNDED by the Dental Program?
Oral Cancer Screening (excluding tests over $100.00)
Root Canal
Fluoride (once per contract year)
X-rays (excluding Cone Beam CT)
Cleanings (not continual within a contract year)
Behavior Management
Disclaimer: Not an All-Inclusive List. All Dental Treatment Procedures are evaluated on a Case-by-Case Basis.

What Services are NOT FUNDED by the Dental Program?
Implants, associated parts, or procedures to prepare for installation
Bone Grafts/Alveoplasty/Gingivectomy/Gingival Flap
Braces/Aligners (Orthodontics)
Periodontal Trays & Supplies
TMJ Related Treatments (i.e. Botox)
Mouth Guards
Oral Health Education
Laser Therapy
Local Anesthesia (Novocaine/Benzocaine/Lidocaine, Desensitive Medicament)
Gingival Irrigation
Atridox/Antimicrobial Agent
Other Drugs and Medicaments (usually covered under Healthcare Plans by prescription)
Dental Hygiene Appliances, Products and Supplies
Disclaimer: Not an All-Inclusive List. All Dental Treatment Procedures are evaluated on a Case-by-Case Basis.

Note: Treatment Plans are subject to review by The Arc of Florida Dental Program’s Consultation Dentists. Recommendations made by those dentists regarding services to be funded establish the final determination for approval of funds.

Questions regarding the “Payor of Last Resort”
According to federal law, Providers are obligated to bill all Third-Party Payers before filing a claim with Medicaid. There are several Federal and State Statutes that govern this requirement. First Section 1902(a)(25) of the Social

Security Act requires participating states to:
“Take all reasonable measures to ascertain the legal liability of third parties…to pay for care and services provided to Medicaid recipients.

It is common for Medicaid beneficiaries to have one or more additional sources of coverage for health care services. Third Party Liability (TPL) refers to the legal obligation of third parties (e.g., certain individuals, entities, insurers, or programs) to pay part or all of the expenditures for medical assistance furnished under a Medicaid state plan. By law, all other available Third-Party Resources must meet their legal obligation to pay claims before the Medicaid program pays for the care of an individual eligible for Medicaid. States are required to take all reasonable measures to ascertain the legal liability of third parties to pay for care and services that are available under the Medicaid state plan.

The Arc of Florida Dental Services Scholarship Program does not have “legal liability” or an obligation to provide dental services to any particular individual. However, the I-Budget Medicaid Waiver has to provide medically necessary services to specific individuals and in fact lists dental services as one of the covered services under the waiver.

While The Arc of Florida is proud to receive funding to provide much needed dental services to Floridians on the I-Budget Waiver and Waitlist, this program does not have a legal obligation to a particular Medicaid recipient and therefore, The Arc of Florida Dental Services Scholarship Program does not replace I-Budget Medicaid Waiver funding for Dental.

Actual Contract Language states:
3. Clients to Be Served
a. General Description

The population receiving services funded by this Contract are the Agency’s clients with developmental and/or intellectual disabilities residing in Florida. The clients to be served shall be children or adults with intellectual and/or developmental disabilities throughout the State who receive services through the DD Waiver whose iBudget cost plan do not include adequate or any funding for comprehensive of preventive dental care, or do not have access to a DD Waiver dentist. The clients to be served shall also include children or adults who receive services through the Waitlist who have comprehensive and/or preventive dental care needs.