Medicaid is a joint federal and state program that provides health coverage to more than 74 million Americans. It's a lifeline for many who might otherwise struggle to afford insurance, including low-income adults, children, people with disabilities, people who are pregnant, and elderly adults. Enrollees can expect access to medical care comparable to private coverage, managing the cost of both acute and long-term care, but what about trips to the dentist? Does Medicaid cover dental care as well?
A simple yes or no, unfortunately, won't suffice here. The answer is complex and depends on a variety of factors, including where you live. However, the short of it is that Medicaid covers dental services for all child enrollees, while coverage for adults varies from state to state.
Let’s break this down in a little more detail and help you to figure out whether or not Medicaid could cover your dental care.
How Does Medicaid Cover Dental Care for Adults?
For adult Medicaid beneficiaries, dental care coverage will depend on where you live. Nearly every state offers coverage for emergency dental services; among other procedures, this includes care for lost or extruded teeth, pain, and swelling in the gums and mouth. Beyond that, unfortunately, less than half of the states currently offer comprehensive dental care to adults through Medicaid. That doesn’t mean you’re left with nothing, though! It’s still essential to research what is specifically available to you.
An excellent place to start is, of course, your state's official Medicaid website. Doing a quick google search for "your state + Medicaid" will typically provide the site you need as the very first result. Just make sure you're going to a website with a URL that ends in .gov.
If navigating state Medicaid pages in search of information seems overwhelming, you can check out the Center for Health Care Strategies, Inc. website, which provides a few reference sheets that can quickly tell you how your state’s Medicaid program approaches dental care for adults.
How Does Medicaid Cover Dental Care for Children?
The good news is, children enrolled in Medicaid and CHIP, the Children’s Health Insurance Program, absolutely have dental care coverage! Now, who qualifies and what they receive will vary slightly based on the program they are enrolled in. We break down the criteria for you below.
Dental Care for Children Under Medicaid
Thanks to the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, Medicaid enrollees under age 21 have guaranteed access to various health services, including dental care coverage. Under EPSDT, “medically necessary” services must be provided to children. What is considered medically necessary is determined at the state level and will vary. At a minimum, children receiving the EPSDT benefit will receive coverage for the following:
Restoration of teeth
Ongoing dental health maintenance such as cleanings
Relief of pain and infections
Dental Care Under CHIP
CHIP is a program that provides healthcare coverage to uninsured children from low-income families who nevertheless do not qualify for Medicaid itself. Like Medicaid, it is managed at the state level based on guidelines set at the federal level. Children under 19 years of age may qualify for CHIP depending on their family’s income.
State-to-state, CHIP may be implemented in two different ways. Here’s how they differ:
CHIP as a Medicaid Expansion
As a Medicaid expansion, CHIP provides the same benefits package found under the EPSDT mentioned above.
Infants, children, and adolescents under age 21 from qualifying low-income families are covered.
States with a separate CHIP program have two different options for providing coverage, which means the packages they offer enrollees might vary slightly in what they offer. So be sure to look into your specific state’s offerings.
These programs must minimally include coverage “necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions,” as specified at 2103(a)(5) of the Social Security Act.
Breaking that down a little more, under a separate CHIP program, children should receive coverage for both emergency and acute dental care.
Finding A Dentist
So, your children are covered, but what about actually finding a dentist who accepts Medicaid? In the past, this could be a real chore, but since 2010, the Centers for Medicare & Medicaid Services have been working to improve access to dental care services for child enrollees. Through the Children’s Oral Health Initiative, CMS has seen significant improvements in ease of access to dental services for children.To make your search a little easier, states are required to post a listing of all participating dental providers on InsureKidsNow.gov.
The question of whether or not Medicaid covers dental care is a complex one with no quick answer. While Medicaid enrollees can expect some level of coverage for their dental care, just what that means varies by state and age. Figuring out just what that means can be intimidating, but we hope that this article has set you up with a good knowledge base and the resources you need to fully utilize the healthcare options available to you.