Medicaid sometimes covers restorative dental services for adults in both program modules. Restorative care repairs or replaces decayed, damaged, or missing teeth. Medicaid sometimes covers adult oral surgery services in both modules of the program. An oral and maxillofacial surgeon treats diseases, injuries, and defects of the mouth, teeth, jaws, face, head, and neck.
Medicaid pays for oral surgery under the health insurance component when medically necessary. Medicaid pays for other oral surgery services under the dental insurance element in states that provide the benefit. If you live in one of the remaining thirty-four states, see below to determine what other emergency dental services your coverage might include. For example, people with oral surgery benefits may benefit from urgent extractions of painful teeth.
Medicaid doesn’t seem to cover orthodontic braces under the dental insurance element in any state. The time to address a disabling malocclusion is before the age of 21.Almost all states (4 and Washington, DC) currently provide dental benefits for adults, and 15 states provide extensive dental benefits (including more than 100 minor and major diagnostic, preventive, and restorative procedures), and 19 states that provide limited dental benefits (including fewer than 100 dental procedures) , and 13 states that provide emergency-only dental benefits (including pain relief and extractions). National Center for Biotechnology Information, USA.
National Library of Medicine 8600 Rockville Pike, Bethesda MD, 20894, USA. Untreated dental disease causes pain, infection, poor nutrition and may limit social interactions, including employment opportunities. Medicaid covers dental services for all enrolled children as part of a comprehensive set of benefits, known as the Early and Periodic Detection, Diagnosis, and Treatment (EPSDT) benefit. In addition, if a dental condition is discovered through a regular dental exam and requires treatment, the state must also provide the necessary treatment, even if it is not normally part of what that state covers.
In other states, such as Georgia, a dental emergency must be life-threatening or performed in an emergency room as part of a larger medical procedure. File your claim with this Medicaid dental plan when you have a medically necessary reason that leads you to need oral care. While a doctor may examine your child’s mouth during a routine physical exam, this is not a substitute for a dental exam by a Medicaid dentist. Dental services must be provided at intervals that meet reasonable standards of dental practice, and at other intervals, as indicated by medical necessity, to determine the existence of a suspected disease or condition.
Therefore, there is wide variation between states, with some providing a broad package of oral health benefits, some providing coverage only for emergency dental services, and a small handful continue to not provide dental coverage of any kind. Also, the distinctions between which, if any, dental services are covered by Medicaid, Medicare, and other insurance plans are not always straightforward. Six months later, full dental coverage was restored for pregnant women, enrolled with disabilities and those residing in long-term care facilities. Medicaid pays for other restorative treatments under the dental insurance element when a state supports the benefit, subject to other possible limitations.
Adult Medicaid dental benefits are often the first service sought to reduce or eliminate in money-saving efforts, especially in difficult economic times. Services should include, at a minimum, pain and infection relief, tooth restoration, and dental health maintenance. Dental services are a mandatory service for most people eligible for Medicaid under age 21, as a mandatory component of the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit. The Center for Medicaid Services and CHIP at Medicaid Centers for Services %26 Medicaid is hosting a series of webinars to help states and their collaborative partners improve access to dental services for children enrolled in Medicaid and CHIP.