For millions of Americans who cannot afford health insurance, Medicaid coverage provides access to health care services. Dental care is an option available to Medicaid recipients based on each state's level of Medicaid services.
Function
Medicaid was formed in 1965 under the Social Security Act to federally fund medical benefits for low-income people who meet eligibility requirements. According to Medicaid Dentistry.com, 38 million families, including 3.4 million elderly and persons with disabilities, are covered by Medicaid.
Eligibility
The federal government establishes operating procedures for Medicaid; however, each state oversees its own program. Therefore, types of services differ by state. In most states, Medicaid covers people making 100% of the federal poverty level but some states allow for coverage to those making more than the federal poverty level. Eligibility guidelines for Medicaid for each state are available at govbenefits.gov. Typically, each state covers services of physicians and hospitals, early screenings, diagnostic, laboratory, x-ray, and treatment services.
Coverage
Dental and oral care is covered for qualified Medicaid recipients under 21 years of age in most states. If over 21, coverage varies, depending on the state's policies. Some states cover emergency dental situations, such as surgery, while others only cover basic critical care. Each state has a list of the maximum number of yearly visits, co-payment requirements, and preventive care procedures covered under Medicaid.
Details of what dental and oral health care is covered by each state are available through a social worker or the state agency that administers Medicaid. Generally, a patient seeking dental treatment must find an approved Medicaid dental care provider and may need a referral to that provider for services such as dentures and orthodontic gear.
Requirements
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) dental services are required for Medicaid recipients under 21. The EPSDT services can include care for dental pain relief, dental hygiene, infections, cleanings, dental crowns, removable prosthesis, and teeth restoration. These are required at regular intervals for every child based on each state's criteria.
Considerations
Some dentists only accept a specific number of new Medicaid patients each year. This may limit choices in service providers or the ability to sign up with an approved Medicaid dentist. States have the option to cover additional dental care procedures with matching federal funds.
