When Does Medicaid Cover Dental Care?

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Medicaid is the federal-state joint health coverage scheme for low-income households and has been implemented in all fifty U.S. states. The program covers basic health care, including physician visits, inpatient and outpatient care, vital laboratory tests, pediatric care, and other essential and optional medical services.

However, if you are wondering whether Medicaid covers dental care, this article will give you a full overview of the dental benefits offered by this government health insurance program. Meanwhile, if you’re looking for an emergency dentist near you, head on to Teledentistry.

What is Medicaid?

Medicaid is one of the largest publicly funded medical insurance programs in the United States. It provides health coverage for low-income families, minors, pregnant women, senior citizens, and individuals with disabilities. These people are usually referred to as “medically needy” or “poor.” 

The purpose of Medicaid is to provide health care coverage to the poor and low-income populations in the U.S. The applicant must be a citizen of the United States or an immigrant legally residing in the country to qualify for Medicaid.

The program was initially launched in 1965 as a joint federal and state program, but currently, it is run by each state individually through the Center for Medicare and Medicaid Services. Since each state has different rules and regulations regarding its Medicaid program, it is important to consult your state’s Medicaid department to learn about the specifics of your particular situation. 

What’s covered and what’s not under Medicaid? 

As per the Centers for Medicare & Medicaid Services (CMS), the program offers the following health-related services in all 50 participant states:

  • Inpatient and outpatient coverage
  • Physician services
  • Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
  • X-ray and other laboratory services
  • Nursing facilities
  • Midwifery services
  • Family planning
  • Pediatric services
  • Home health care
  • Transportation to hospital and other medical center coverage
  • Tobacco addiction control counseling for during pregnancy

However, coverage of some optional services can differ from state to state, such as –

  • Prescribed drugs (even though it comes under option head in the Medicaid program, all states cover the cost of prescription drugs to some extent)
  • Physiotherapy
  • Chiropractic therapy
  • Occupational therapy
  • Chiropody
  • Prosthetic devices
  • Hearing disability
  • Speech impairments
  • Adult vision care
  • Adult dental care
  • Respiratory issues
  • Hospice service

For children, though, all states cover the following services under Medicaid:

  • Physiotherapy
  • Vision care and eyeglasses
  • Dental care
  • Chiropody
  • Prosthetic implants
  • Hearing disorders and hearing aid devices
  • Psychological care
  • Hospice facility

Does Medicaid cover dental care?

The answer to this question can’t be a simple yes or no because every state implements its rules and regulations regarding dental care under Medicaid coverage.

While in the case of a minor aged below 21 years, all states are required to offer comprehensive routine and emergency dental coverage. However, whether the adult category includes the same benefits depends on the specific state. 

Therefore, when it comes to adult dental care, it is recommended to check with your state’s Medicaid program to find out the type of dental coverage you are entitled to.

Adult dental care in general cases under Medicaid

Apart from 3 states, namely, Tennessee, Maryland, and Alabama, all other states offer at least some sort of dental care for their adult Medicaid beneficiaries. However, while Tennessee and Maryland do not have any dental care provision for their healthy adult residents, they make an exception in cases of pregnant women.

Dental care for adults in emergency cases

Emergencies may arise sometimes, and in such situations, it is best to know whether your state provides dental care in case of an emergency. There are 8 U.S. states that make it possible for their adult citizens to get dental care and Emergency Dentist through the Medicaid program in case of an emergency. They are Hawaii, Nevada, Texas, Georgia, Florida, New Hampshire, Arizona, and Utah.

Limited dental coverage for adults

Around fourteen states in the USA offer limited dental care coverage for adults, being Delaware, Michigan, South Carolina, Arkansas, Pennsylvania, Louisiana, Minnesota, Nebraska, Kansas, Mississippi, Indiana, Missouri, Wyoming, and Kentucky. Only minor procedures such as cleaning, tooth fillings, dental imaging, and emergency care are typically covered under limited Medicaid dental coverage. 

Comprehensive dental coverage for adults

Rest other 25 states and Columbia district have incorporated comprehensive adult dental care under their Medicaid program, which includes orthodontics, prosthodontics, endodontic care, periodontal care, restorative care, preventive care, dentures, and implants.

What are the benefits of Medicaid dental care?

As mentioned earlier, Medicaid is a public health insurance program that helps cover healthcare costs for low-income groups. While it offers many benefits, dental care is something that could help many.

Although dental care is considered an optional benefit in Medicaid, it makes sense to get enrolled in Medicaid at the earliest to access the following benefits whenever and wherever applicable:

Preventive dental care

With Medicaid, a person can avail of preventive dental care services such as regular checkups, x-rays, fluoride treatments, oral hygiene instructions, sealants, and more. If you suffer from severe dental problems, your dentist might refer you to a specialist or a dental surgeon. You will be able to get assistance from them in terms of braces, root canal treatment, and surgery.

Emergency dental care

If you face a dental emergency, you can get coverage from your state Medicaid program. Emergency dental care includes extractions, bridge placement, crowns, implants, and other related procedures.

Orthodontic care

Orthodontics is another important aspect that is covered by Medicaid in some states. However, you may or may not get coverage for braces, veneers, and other orthodontic treatment options – depending on your state.

Prosthodontic treatment

If you are suffering from a decayed, broken, or fractured tooth, you can get coverage from your state Medicaid program to restore, repair, or replace damaged teeth.

Periodontal disease treatment

Periodontal disease can lead to gum infection and loss of bone and teeth. If left untreated, it can become a severe issue. Your state Medicaid program can help cover cleaning, scaling, and other related procedures.

Restorative care

Restorative care involves repairing and restoring the function and appearance of a patient’s natural teeth. If your teeth require any restoration procedure, you can get coverage from your state Medicaid program.

Is Medicaid good for dental emergencies?

Long answer short, yes, Medicaid is great for dental emergencies! Just like many other private insurance programs, Medicaid also covers dental emergencies. 

Medicaid may not always offer the same level of dental care as a private insurance plan. However, it is still a great option if you want to get dental work done in emergency circumstances. However, those residing in Tennessee, Maryland, and Alabama should check other options, as these three states do not cover any dental care under Medicaid, not even in emergencies.

Endnote

When it comes to dental care under Medicaid, there is no universal policy. Each state has its own set of rules and regulations regarding dental care. Hence, it is better to contact your local Medicaid office to learn about the exact details of your situation and eligibility requirements to enroll in Medicaid.

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