NJFC Dentist Treating Children and Adults with Intellectual and Developmental Disabilities
Horizon NJ Health ensures that members with special needs get care and services equal in quality and accessibility to services provided to all Horizon NJ Health members.
Who are Horizon NJ Health's members with special needs?
Adults with special needs are individuals who have complex or chronic medical conditions that require specialized health care services. They may have physical, intellectual, behavioral or developmental disabilities and/or a Substance Use Disorder.
Children with special needs are individuals who have or are at increased risk of having a chronic physical, developmental, behavioral or emotional condition, and who require more health‐related services than the general population.
If you are the member, or the caregiver, parent, or guardian of a member who has a special health care need, this guide will help you access dental care.
Frequently Asked Questions
- Call the Care Management department at 1‐800‐682‐9094 x89634 (TTY 711).
- A Care Manager will do a Comprehensive Needs Assessment (CNA) by phone. The screening will decide the level of care management you may need.
- Once a Care Manager is assigned, they will be your primary contact to coordinate any dental services you need.
- Your Care Manager will help you find a dental provider that can accommodate your special health care need (i.e. wheelchair accessibility, sedation, etc.).
- Diagnostic, preventive, restorative, endodontic, periodontal, prosthetic, oral and maxillofacial surgical, as well as adjunctive services.
- Examples of covered services include (but are not limited to): routine examinations, fillings, crowns, root planing and scaling, X‐rays and other diagnostic imaging, extractions, cleanings/prophylaxis, topical fluoride treatments, root canal treatment, apicoectomy, dentures (complete and partial), and fixed prosthodontics. For a complete list of covered dental services, please review the Your Covered Benefits and Services section of your Member Handbook. For information about emergency dental care, please review the Emergencies section of your Member Handbook.
- Orthodontics (with age restrictions and documentation of medical necessity)
- Additional diagnostic, preventive and periodontal (gum) services shall be available beyond the frequency limitations of every six months and be allowed four times a year to members with special needs. The provider will need to report and document the medical necessity for consideration.
- Pre‐authorizations are required for major dental services, such as root canals, crowns, scaling and root planning (deep cleaning), etc. Please contact your dental provider for more information.
- All general dentists and dental specialists are listed in the Doctor & Hospital Finder.
The Doctor & Hospital Finder is updated daily, and gives a brief overview of providers with American Disabilities Act (ADA) accommodations such as wheelchair accessibility.
You can use the Doctor & Hospital Finder, to identify an office or provider based on the parameters selected (i.e. mileage, language, specialty, etc.). Follow the steps below to find a dentist:
- What type of care are you looking for?
- Choose Dentist
- Select your plan
- Choose Horizon NJ Health
- Enter doctor's name, specialty, service or affiliation
- Enter a specific doctor's name or office
- Choose a specialty (i.e. pediatrics, oral maxillofacial surgery, etc.)
- You can narrow your search to a location.
- Enter a county, city or address of
The list of available dentists based on the first selection of your search parameters will be displayed. You will then have the option to select additional criteria that fits your needs (i.e. developmentally disabled, language, non-verbal, wheelchair accessibility, etc.).
You can also download, save, print or email your results. Click Export Results and select the option that you want. Refer to “How do I schedule dental appointments?” for questions to ask to ensure the office can accommodate your special health care needs.
If you have a specific health care need that may need additional accommodations, Horizon NJ Health recommends that you contact a Care Manager to assist with coordinating dental services.
A Horizon NJ Health Care Manager will complete a Comprehensive Needs Assessment. After the assessment is complete, a Care Manager will advise what level of care management is needed and develop a Plan of Care. If you have a complex medical condition, physical or developmental disability, severe illness, or a dental issue, you will work with yourCare Manager, PCP or specialist to create a care plan that fits your needs.
Based on your medical background, the Care Manager can match you with a dental provider or office that can accommodate your specific health care needs.
Contact your Care Manager if additional accommodations are needed (i.e. sedation, hospital privileges, etc.) by calling 1-800-682-9094 x89634 (TTY 711).
- The NJFC Directory of Dentists Treating Children under the Age of 6 is a directory listing every pediatric and general dentist seeing children through 6 years of age who participates with Horizon NJ Health. This directory is updated quarterly.
- Transportation is covered by Fee‐For‐Service.
- Medicaid Fee‐for‐Service covers all non‐emergency transportation, such as mobile assistance vehicles (MAVs), and non‐emergency basic life support (BLS) ambulance (stretcher). Livery transportation services, such as bus and train fare or passes, car service and reimbursement for mileage, are also covered.
- It may require medical orders or other coordination by the health plan, PCP or providers.
- Call Modivcare at 1‐866‐527‐9933 (TTY 1‐866‐288‐3133) or visit modivcare.com to make transportation reservations.
We recommend that your Care Manager help you with transportation reservations for dental appointments.
We recommend that your Care Manager help you choose a provider and schedule dental appointments. However, members, parents, caregivers and guardians can choose a provider and make their own appointments.
When contacting an office, tell the office staff about your specific special health care needs. They can identify the dentist on staff that can address your special health care needs and schedule appropriately.
You can ask additional questions about offered accommodations. Examples of questions to confirm if the dental provider can accommodate specific special needs are:
- Is there wheelchair or stretcher accessibility?
- Is there any form of sedation provided in the office (i.e. nitrous oxide (laughing gas))?
- Does the provider have Operating Room (OR) or Ambulatory Surgical Center (ASC) privileges to provide dental services under general anesthesia?
- Can you accommodate my specific special health care need?
Prior authorization is required for all members with special health care needs when it has been determined by their dentist that dental services should be given in an OR or ASC.
The Care Manager should be contacted to assess the member's medical history. If sedation is needed, the Care Manager will recommend a dental provider that can provide the service.
Members are required to meet with the provider and the provider will determine if the member needs OR, in‐office sedation or ASC to complete dental services. The member's medical history and condition will be discussed with the provider before any treatment plan is developed. For more information, please review the Programs for You and Your Family section of your Member Handbook.