Requests for dental services not covered by the MediPlan card, such as partial plates for clients with noticeably missing or malformed teeth or other dental procedures, must be considered on a case by case basis to determine if the condition is a barrier to employment.
- (Worker) If the client does not have a dentist who accepts the medical card, give the client Form 2151 referring them to a dentist who does accept the medical card.
- If the Family Community Resource Center is not aware of a dentist who accepts the medical card, call DentaQuest at 1-888-286-2447 for their assistance in locating a Medicaid-enrolled dentist.
- (Dentist) Gives the client a written description of the required dental procedure and a cost estimate. The statement must have the dentist's name, address, phone number, license number, Social Security number or FEIN, description of the required dental procedures, fees, and dentist's signature.
- (Client) Submits the dentist's statement to the Family Community Resource Center.
- (FCRC) If there is a question about a dentist's charge, contact HFS Bureau of Maternal and Child Health Promotion at (217) 557-5438.
- (LOA) Makes the decision to approve or deny the request.
- (Worker) Notify the client of the decision by sending Notice of Decision on Request for a Financial Assistance Increase/Special Authorization (Form 1934).
If the services are approved, Form 1934 refers the client back to the dentist.
- (Worker) Send a copy of Form 1934 to the dentist.
NOTE: Make sure the Family Community Resource Center address appears on the notice.
- (Dentist) When the dental work has been completed, sends the dental bill to the FCRC.
- (FCRC) Prepare a Form C-13 and send it with the dentist's bill to:
DHS Vouchering Unit
100 South Grand Avenue East, 1st floor
Springfield, IL 62762
- (Dentist) Receives payment from DHS Vouchering Unit at the maximum allowable Medicaid rate or the actual charge, whichever is less.
- (FCRC) Keep copies of the dentist's statement, client notice, and Form C-13 in the case record.