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19.3.2 THSteps Dental Eligibility
The client must be Medicaid- and THSteps-eligible (birth through 20 years of age) at the time of the service request and service delivery. However, Medicaid approved orthodontic services already in progress may be continued even after the client loses Medicaid eligibility if the orthodontic treatment is begun before the loss of Medicaid eligibility and before the day of the client's 21st birthday and is completed within 36 months. The client is not eligible for THSteps dental preventive or therapeutic benefits if the client's Medicaid Identification Form (Form H3087) or Medicaid Eligibility Verification Form (Forms H1027 and H1027-A-C) states any of the following:
• Emergency care only.
•Presumptive eligibility (PE).
•Qualified Medicare beneficiary (QMB).
A check mark will be present in the "Dental" column of the client's Medicaid Identification Form (Form H3087) to indicate that the client is eligible for dental services. A message (THSteps Dental check up due) may appear below the client's name on the monthly client Medicaid Identification Form (Form H3087) stating the client is due for a dental check up, which serves as a reminder to parents to contact their child's dentist and schedule an appointment for their periodic dental check up. This message is printed on the H3087 when the client has not received any dental services (diagnostic, preventive, therapeutic, or orthodontic) for a period of six months.
Clients are not eligible for CCP services on or after their 21st birthday, but are eligible for non-CCP THSteps dental services (see fee schedule for CCP and non-CCP reimbursed services) through the end of the month of their 21st birthday.
Note: If a client has a birthday on any day except the first day during the month, the new eligibility period is considered to begin on the first day of the following month.
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