While Medicaid guidelines require states to provide some level of dental care for children, states are not required to provide dental benefits to adults. Each state decides whether to provide those and, if so, which dental services they will cover.1
What is Medicaid?
Medicaid is a government program that provides health coverage for low-income adults, children, pregnant women, the elderly and the disabled.2 People who are eligible for Medicaid can go to doctors, hospitals, dentists and other health care providers and Medicaid, rather than the patient, pays the bill.
The federal and state governments fund Medicaid jointly; the states run the programs and decide what benefits they will pay for while the federal government provides funding and guidelines.
Dental health and your overall health
Dental health affects your overall health. Problems in your mouth can affect the rest of your body.3 Not being able to see a dentist is related to a range of health problems. Periodontal disease (gum infection) is associated with an increased risk of cancer and cardiovascular diseases.4
Low-income adults suffer a disproportionate share of dental disease and are nearly 40% less likely to have a dental visit in the past 12 months, compared to those with higher incomes. Forty-four percent of low-income adults ages 20 to 64 have untreated tooth decay. Adults who are disabled, homebound, or institutionalized have an even greater risk of dental disease.5
What dental procedures does Medicaid cover?
Although Medicaid covers comprehensive dental services for children, no such requirement exists for adult coverage. States decide what dental services they will cover for adults, so the benefits vary widely from state to state.
Many states limit coverage to only tooth extractions or to specific demographics, such as pregnant women. With the wide flexibility given to the states, many provide only emergency dental services for adult patients. Medicaid does not set a minimum requirement for the dental coverage states provide to adults like they do for children.
As of September 2019, less than half of state Medicaid programs offered comprehensive adult dental benefits. But, 47 states and the District of Columbia offered at least emergency services to their adult Medicaid patients. Emergency services include uncontrolled bleeding and traumatic injuries.6
To find out if your state covers services like braces, dentures, root canals, wisdom teeth removal, or veneers, contact your local Medicaid office.
Will Medicaid cover dental for my kids?
The Affordable Care Act expanded Medicaid eligibility so that the program could cover more low-income citizens.7 In addition to making more people eligible for coverage, this expansion provided funds that many states used to improve their dental coverage. Some states increased the Medicaid reimbursements for children’s dentistry as well as expanded the number of services covered.
Medicaid covers many dental services for children. The federal program gives states a lot of flexibility to design their own program within federal guidelines. This means covered dental services for children also vary from state to state.
At a minimum, states must provide dental services for children through the Medicaid program that covers the following:
- Pain relief and infections (such as extractions and treatments for infections)
- Teeth restorations (such as fillings and some types of crowns
- Maintenance of dental health (such as examinations, cleanings, fluoride treatments, and sealants)8
Dental services for Medicaid-eligible children cannot be limited to only emergency services. All medically necessary care must be provided. Each state determines its own definition of which dental services fall into the “medically necessary” category.
Making Medicaid work for you and your child
If your child needs dental services, it is best to first check with your local Medicaid office to determine the services that are covered and the dental offices that work with Medicaid insurance.9
If you or another adult living in your home needs dental treatment, the same advice applies. Because of the wide variety of coverage levels, your local Medicaid office is the best place to start to get a list of offices that accept Medicaid payment as well as a list of covered services.
If you find that you are not eligible for dental treatment under Medicaid, you can purchase individual or family dental insurance.
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Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice. This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.