Medicaid Dental – A Guide to State-Sponsored Dental Benefits


medicaid dentalMedicaid dental coverage is, for a lot of people, the only access to affordable but high quality dental health care. Medicaid is a program being run by the federal and state governments. The objective is to deliver health care to all citizens who are not able to provide health care for themselves. The dental care program is especially people because dental care happens to be one of the most easily overlooked aspects of health care.

The program focuses mainly on the poor, and encompasses the elderly, the children, and the disabled. For those who wish to apply, you have to find the Medicaid center in your state or go online and check your state department website for any instructions about applying for Medicaid in electronic methods. Medicaid services are a requirement for all states, so do not stop searching until you find the right office to talk to.

Important Information Regarding Medicaid Dental Coverage

  • Dental Services Covered
  • Financial Eligibility
  • Categorical Eligibility
  • Special Medicaid Dental Rules for Children Under 21

1. Dental Services Covered

Medicaid dental coverage ensures that, despite the covered service, citizens still receive high quality care. This is why the program provides quite a comprehensive coverage that is individually decided on the state level. Aside from the cost of the procedures, Medicaid also provides cover for laboratory fees, tooth extractions, tooth restorations, and medications needed by the patient.

There are some restrictions though. It has been specified that Medicaid will only cover certain extensive treatments such as jaw reconstruction but only if the problem was caused by an accidental injury. Jaw reconstructions out of the patient’s desire to look better are usually not accepted.

2. Financial Eligibility

Before a person can enjoy the benefits of Medicaid, he or she is required to meet a list of eligibility standards and requirements, as per government guidelines. Eligibility requirements differ for each state. Mainly, there are two types of eligibility a citizen should meet in applying for a Medicaid coverage. The first is financial eligibility. Only low income citizens who are unable to pay for their own dental care.

The reason why the eligibility process is very strict is that Medicaid wants to be certain that the privileged care it provides really goes to those who need it and cannot get it in any other way. Part of the objective is to reduce the number of citizens who do not receive proper oral care at all.

3. Categorical Eligibility

Aside from the financial eligibility requirements, there are also categorical eligibility, which states that only low income individuals who are under 21 years old, are senior citizens, are pregnant, and are disabled can avail of the Medicaid benefits. Even though a person is not exactly low income, if they are senior citizens, are pregnant, or are disabled, they may be considered eligible. States have different ways of dealing with such distinctions though. Those who are under 21 years old, however, should meet both categorical and financial eligibility requirements.

4. Special Medicaid Dental Rules for Children Under 21

Those who are under the age of 21 who wish to be part of Medicaid need  to undergo the EPSDT or Early and Periodic Screening, Diagnostic, and Treatment. This shows that Medicaid also focuses on the early detection and prevention of medical conditions and dental problems especially for younger patients who can still get a good start on their dental health care.

When a child under 21 is under Medicaid, he or she is required to seek dental services every six months. It will be the state’s decision as to whether the child needs more visits on top of the two visits required each year, and this decision will be made following a consultation with dental care providers. Under the EPSDT program, Medicaid also becomes responsible for the young person’s preventive, restorative, and emergency dental procedures.

Some Disadvantages of Dental Care from Medicaid

The Medicaid dental program is not without downsides. Over the years, Medicaid has encountered several problems, such as patients not showing up for appointments, dentists disappointed with their income losses and wasted time, and rising prices of prescription drugs, which also destabilizes the program’s finances and causes frozen reimbursement requests. However, the promise of affordable and even free dental care is still a huge offer to turn down especially for those who consider dental care a rare resource due to their financial situations. Therefore, Medicaid really is beneficial but only for the right people.