How It Works

The Dental Program

Eligibility

The Dental Care for Children with Special Needs Program is designed for children under 21 with one or more of the following conditions:

Cerebral Palsy
Muscular Dystrophy and related neuromuscular disorders
Intellectual Disabilities, including Downs Syndrome, for profound to 2 years overall delayed. Documentation from the child’s licensed psychologist, or physician, is required.
Dental Care for Organ Transplant recipients pre & post

Medicaid patients are not covered by the program. The Dental Care for Children with Special Needs Program is the secondary carrier when insurance is involved and acts as the primary carrier if no insurance is available, and covers the maximum allowable fees as determined by the Humanitarian Foundation.

How to Apply

The Dental Care for Children with Special Needs Program has representatives from local chapters of Grottoes International who are known as “Drs. of Smiles.” These representatives serve as liaisons with the parents and dental offices to see that all paperwork is provided and properly completed. They also file the child’s application with the Humanitarian Foundation office for processing. The Dr. of Smiles maintains contact with the parent and dentist throughout the course of the child’s care.

All application forms must be completed and submitted to the local Dr. of Smiles. When no representative is available in your area or state, your case will be processed directly through the national office of the Humanitarian Foundation. Please call the office at (614) 933-0711 or e-mail hf@hfgrotto.org.

Application Forms

– Click on the links below to download:

Download Form #1 or Use Online Form
Parent or Legal Guardian must complete and submit to the local Dr. of Smiles, or directly to the Humanitarian Foundation if a Dr. of Smiles is not available

Download Form #2
The dentist must complete all items and spaces. The dental office may print off a pre-treatment evaluation, but it must be attached to a completed form. See Dental Office Procedures for more information.

Additional Guidance for Parent/Guardian and Dentist

– Click on the links below:

Dental Office Procedures

We look forward to working with you to help your child maintain that beautiful smile.

As of late 2025, the legal landscape remains firm: because Medicaid and CHIP are “payers of last resort,” their payments are legally considered payment in full. This creates a direct conflict with the HF program, which cannot supplement a government payment.

Guide for Parents: Choosing the Right Path

If your child has a qualifying special needs diagnosis (Cerebral Palsy, Muscular Dystrophy, Intellectual Disability, or Organ Transplant), you must decide which “bucket” of funding to use.

When to use State Programs (Medicaid/CHIP)

The Benefit: Most state programs are legally required to provide EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) for children under 21. This covers almost everything: cleanings, fillings, crowns, sedation, and medically necessary surgery.
The Catch: Your choice of dentists is limited to those who accept the state-issued card.
Recommendation: Use this if you have a local “Special Care” dentist who already accepts your state’s Medicaid/CHIP plan.

When to use the Humanitarian Foundation (HF)

The Benefit: HF can act as your primary payer if you have no insurance, or as a secondary payer if you have private insurance (e.g., Delta Dental) that leaves you with high out-of-pocket costs.
The Catch: You cannot use this if your child is enrolled in a state Medicaid/CHIP program. HF requires a “Pre-Treatment Estimate” from the dentist; if that dentist is also billing the state, they cannot legally sign the HF forms.
Recommendation: Use this if you have private insurance with high deductibles or if you cannot find a Medicaid dentist and are willing to pay a private dentist using HF funds (and not use your state card).

Guide for Dentists: Compliance & Administration

Treating special needs patients under these programs requires strict adherence to “Balance Billing” laws.

The Medicaid Block: If you are a Medicaid provider, you cannot accept HF funds for a patient who is using their Medicaid benefit for that visit. Doing so is considered “Balance Billing” and is a violation of your provider agreement.
The HF Workaround: You can treat a child using HF funds only if:

The patient has Private Insurance (you bill the insurance first, then HF pays the remainder).
The patient is Uninsured (HF pays 100% of the allowed fee).

The “Doctor of Smiles” Connection: Before beginning treatment, you must coordinate with the local Grotto “Doctor of Smiles” to ensure the Pre-Treatment Estimate is approved.

Is it legal for a parent to use HF instead of Medicaid or state funded program even if they are available in their state?

Yes, it is perfectly legal for a parent to choose the Humanitarian Foundation (HF) Grottoes program over Medicaid or other state-funded programs. Families have the right to choose how to pay for their child’s healthcare.

However, while it is legal, there are strict procedural and financial consequences you must understand to ensure you don’t accidentally lose your other benefits or get stuck with a bill.

The Legal Realit y: “Right to Decline”

In the United States, enrollment in Medicaid or CHIP is voluntary. Even if your child qualifies based on income or a special needs waiver (like a Katie Beckett/TEFRA waiver), you are not legally forced to use it.

You can “Opt-Out”: You can choose to pay for a service out-of-pocket, use private insurance, or use a charitable program like HF.
The “Uninsured” Status: For the purpose of the HF program, if your child is not currently enrolled in Medicaid/CHIP, they are considered “uninsured” for that dental visit. This allows the Grottoes to act as the Primary Payer.

The Medicaid Eligibility Trap

The conflict isn’t usually about whether it’s “legal” to use HF, but whether your current enrollment blocks the dentist from accepting HF funds.

If the Child is ALREADY Enrolled in Medicaid:

If your child is currently on a Medicaid roll, most dentists cannot accept HF money. This is because state laws require the dentist to bill Medicaid first, and once Medicaid pays, the dentist is legally barred from taking any other money (the “Paid in Full” rule).

Solution: You would have to disenroll the child from Medicaid or formally “Opt-Out” for that specific benefit year/period, which can be a long administrative process.

If the Child is ELIGIBLE but NOT Enrolled:

This is the “sweet spot” for the Grottoes program. If you have kept your child off state programs (perhaps due to the difficulty of finding a Medicaid dentist), you can apply to the HF program as an uninsured patient.

Requirement: You must prove that no other insurance (Private, Medicaid, or CHIP) is active at the time of treatment.

Risk Warning: Impact on Other Ben efits

Before you decline Medicaid to use the Grottoes program, you must check how it affects your child’s other special needs services.

[!CAUTION]

The SSI Link: In many states, receiving SSI (Supplemental Security Income) automatically enrolls a child in Medicaid. If you “cancel” Medicaid, you might inadvertently trigger a review of their SSI eligibility.

The Waiver Link: If your child is on a Home and Community-Based Services (HCBS) Waiver, Medicaid is often the “umbrella” that pays for their therapies, equipment, and home nursing. Opting out of the dental portion may not be possible without opting out of the entire waiver.

Guide for Navigating the Choice

If you want to use the Grottoes program instead of a state-funded program, follow this checklist:

Check Enrollment Status: Confirm if your child is currently “Active” in the state system.
Consult your “Doctor of Smiles”: This is your local Grotto representative. Ask them: “If my child is eligible for Medicaid but we choose not to enroll them, will the Foundation still cover the treatment as the primary payer?” (Usually, the answer is Yes).
The “Medicaid Denial” Letter: The Humanitarian Foundation requires a “Denial Letter” from Medicaid to prove that the state won’t pay before they step in.
The “Fee Schedule” Talk: Ensure your chosen dentist is willing to accept the Grottoes’ Fee Schedule. HF pays a specific set rate; if the dentist charges more, the parent may still have to pay the difference (unlike Medicaid, where you pay $0).