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43.1.12 How the THSteps Dental Program Works
THSteps-designated staff (HHSC, DSHS, or its designee), through outreach and informing, encourage the parents or caregivers of eligible clients to use THSteps dental check ups and prophylactic care when clients first become eligible for Medicaid and each time clients are periodically due for their next dental check up.
Upon request, THSteps-designated staff (HHSC, DSHS, or its designee) assist the parents or caregivers of eligible clients with scheduling of appointments and transportation. Medicaid clients have freedom of choice of providers and are given names of enrolled providers. Call the DSHS THSteps Hotline at 1-877-847-8377 for a list of THSteps dental providers in a specific area.
When a client is eligible for a THSteps dental check up, a message is present on the Medicaid Identification Form (H3087 or H3087 STAR) under the client's name. If the client or caregiver believes the client is due for a dental check up and a message is not present, the provider may contact TMHP through the TMHP website at www.tmhp.com or AIS at 1-800-925-9126 to verify that the client is due for a dental check up.
Clients may receive an initial THSteps dental check up at 12 months of age and at 6-month intervals thereafter, through 20 years of age. Clients younger than 12 months of age are not eligible for routine dental examinations; however, they may be referred when a medical check up identifies the medical necessity for dental services. All THSteps clients birth through 20 years of age can be seen by the dentist at any time for emergency dental services for trauma, early childhood caries (ECCs), or any other appropriate dental or therapeutic procedure.
Clients birth through 20 years of age may self-refer for dental services.
Note: Clients enrolled in Medicaid Managed Care are required to choose a medical provider in their health plan's network. The health plan does not reimburse for services rendered by nonparticipating providers. Please contact the specific health plan for enrollment information.
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