Does Medicaid Cover Dental?
Medicaid is one of the most beneficial ways to alleviate financial stress in a medical emergency. However, the complications behind what is covered under Medicaid from state to state can become a source of considerable stress. For example, you may wonder, “Does Medicaid Cover Dental?”
Medicaid does cover dental services for those who have Medicaid, according to HHS.gov. However, this care only applies to those under 21, outlined in the Early and Periodic Screening, Diagnostic, and Treatment range of benefits. Otherwise, dental care is only provided at the discretion of each state offering Medicaid.
In this article, we’ll cover what dental care falls under Medicaid and what kinds of benefits you can expect from Medicaid, no matter which state you happen to live in when it comes to dental health. We will also explore the answers to some of the web’s most frequently wondered questions on this subject so you can be fully informed! So let us get right into this subject.
Does Medicaid Cover Dental?
To thoroughly provide an answer to whether or not Medicaid offers coverage for the cost of dental care, we should first establish what Medicaid is. Medicaid is a program regulated on both a federal level and an individual state level in the United States. The program aims to assist those with limited resources and income in paying for healthcare.
With that being said, Medicaid is a type of healthcare program that offers more extensive benefits than the average Medicare system, which is offered only on the federal level to those who are either older than 65 or fall into a category of particular disabilities and conditions.
Even though Medicaid does work with the states to offer more benefits for those qualified, the downside seems to be that involving state government means some benefits are offered in certain states but not in others based on each state’s discretion. Though federal regulations require all states to offer some benefits, dental care doesn’t fall under this category.
This means that, in most cases, Medicaid doesn’t cover dental care. However, there is one exception those who have Medicaid services can count on.
The Early and Periodic Screening, Diagnostic and Treatment benefit, or EPSDT, does require all of the states which offer any Medicaid to provide some level of dental services for beneficiaries.
The qualifications, as mentioned above, are that they must be under 21 years of age. This allows dental health issues to be caught and treated while people are young before diseases progress. However, states still have a slight variance in what they offer depending on the usual state standards for dental practices.
For example, a state’s leading child dental organizations hypothetically recommend yearly dental health screenings. In that case, this is the number of dental health screenings provided in that state. In the following given state, if dental organizations recommend something different, Medicaid may not offer the same standard of services.
What Dental Care Does Medicaid Offer in Every State?
We have established that although state benefits do not cover all dental care situations, federal regulations cause all states to offer some level of dental care through the EPSDT benefit for those under 25 years of age. However, the question is, what kind of dental services are offered, as a baseline, for every 25-year-old or younger beneficiary, no matter where they live?
In the list below, you’ll find the minimum standard of dental health situations that Medicaid must cover for those under the EPSDT benefit throughout each state:
- Tooth restoration – If teeth are damaged or even missing, causing problems with oral functions, Medicaid must cover the cost of restoring that function.
- Infection and Pain relief – If you have an infection, such as a tooth abscess or other infected wounds causing pain in the mouth, Medicaid is required to cover the cost of treating the infection and managing the pain it causes.
- Dental health maintenance – These fall under what is known as “preventative” healthcare services. These benefits include covering the cost of x-rays, cleanings, sealants, checkups, and any tertiary operations like crowns, oral surgery, root canals, and fillings.
These three types of dental care benefits mean that those under 25 and receiving Medicaid benefits can expect many short-term solutions to dental health problems to be covered in cost by Medicaid, not just emergency services. This goes for any state that offers Medicaid.
Which States’ Medicaid offers Adult Dental Care For Emergencies?
When it comes to emergencies, those over 25 can still expect Medicaid to cover some emergency costs for dental issues if they live in the following states:
- New Hampshire
These eight states will provide the services mentioned above for children, but for adults, they will only cover the cost of healthcare services that remove infection and relieve pain. For example, if you go to an emergency room suffering from an abscess or infected gums, you will likely receive emergency dental care and have the cost covered by Medicaid.
Which States’ Medicaid Offers Limited Adult Dental Care?
Though only eight states provide dental care for adult emergencies, many more provide what is known as “limited” dental care. This means that the Medicaid benefits in these states can cover less than 100 preventative, diagnostic, or therapeutic procedures, all of which must be recognized by the American Dental Association.
The states that offer at least these few limited Dental care services through Medicaid for those over the age of 25 are as follows:
- South Carolina
The above-listed fourteen states will be able to give coverage for services like x-rays, tooth cleanings, tooth fillings, minor restorative procedures, and emergency care like treating infection and pain. However, remember that large-scale restorative dental procedures will only be covered in some of these 14 states.
Which States Do Not Provide Any Adult Dental Coverage?
Unfortunately, some U.S. states only abide by the bare minimum of dental services covered under the federally mandated Early Periodic Screening, Diagnostic, and Treatment benefits. This means they do not provide any adult dental benefits. These states are listed below:
Though all three of these states cannot generally provide coverage of dental services for adults, Tennessee and Maryland make an exception for Medicaid beneficiaries who are pregnant and over 25.
The Future of Medicaid Dental Coverage
Even though not all states are federally regulated to provide all-important dental care for adults, two of the three that provides nothing in the way of dental care beyond the EPSDT benefits may be changing that. Both Maryland and Tennessee are currently attempting to extend the benefits their Medicaid coverage allows to more adults.
For example, Tennessee allotted some state budgets, around $25.5 million, toward dental benefits for adults receiving Medicaid. Additionally, Maryland is following suit by trying to match other states which offer limited dental care coverage for Medicaid beneficiaries.
Frequently Asked Questions
Are you looking for more information on the states that offer dental care via Medicaid benefits and to whom these benefits may apply? We have gathered answers to some of the internet’s most frequently asked questions so you can be as well-informed as possible on these issues! Check out our list below:
For example, does full Medicaid cover dental in Alabama?
As mentioned above, Alabama is one of three states in the U.S. that offers no coverage for any dental care for anyone needing it over 21 years of age. They are joined in this lack of coverage by the states of Tennessee and Maryland.
Does Georgia Medicaid cover dental?
Georgia Medicaid covers some dental care levels for children and adults enrolled in Georgia’s PeachCare for Kids or Medicaid itself. Beneficiaries must also be enrolled in organizing the Interpregnancy Care Component of Planning For Healthy Babies.
Does Medicaid Cover Dental in New York?
New York is one of the states with more benefits in terms of dental care for adults and offering coverage as part of federal regulations to those under 25 years of age.
To sum up, dental care has only been covered in a limited fashion throughout all states thanks to federal regulations. If you are under 25, you can expect to receive coverage for most forms of dental care no matter where you live, according to the state standard of dental health.
However, if you are older than 25, your dental coverage via Medicaid benefits may vary from state to state. For example, Alabama offers no coverage for adults needing dental care, but Kentucky will treat emergency dental needs and cover the cost of minor restorative procedures.