Medicaid Dental Coverage

The Medicaid program for dental services, as defined under Title XIX of the Social Security Act, is a dental service that is optional for adults in the United States. An adult is defined as anyone over the age of 21. However, as part of the Early and Periodic Screening, Diagnostic and Treatment or EPSDT program, most Medicaid eligible individuals aged under 21 will be required to have access to the Medicaid service.

Medicaid for people under 21 years of age
Medicaid developed EPSDT to be a far-reaching child health care program. The target of the program is early diagnosis and prevention of medical conditions. Should the prevention not take place, then treatment is provided. Each state needs to provide EPSDT as a mandatory service as part of its Medicaid program.

A reasonable standard of dental practice must be provided by the dental services at the agreed intervals. The standards of dental practice are set by the state once consultation with recognized and respected child health dental organizations has taken place. Regular interval check-up periods will be agreed, as well as the possibility for those under 21 to have access to dental services for treatment of infections and pain relief. Added to this are services for the general maintenance of dental health, as well as the restoration of teeth. The dental services that the state offers, as part of EPSDT to recipients, is not just limited therefore to emergency services.

As a result of a direct referral to a dentist, oral screening may be carried out as one aspect of the physical exam. However it is not considered as a complete substitute to a dental examination carried out by a qualified dentist. Every child will need to have a direct dental referral periodically as defined in the state’s schedule. Specific dental services are not laid out in exhaustive detail by the Centers for Medical and Medicaid Services, however, EPSDT specifies the services in the Medicaid program that are coverable should always be available to all EPSDT recipients if it is decided that medical intervention is needed. The state itself sets the criteria of what is classified as medical necessity under the Medicaid program.

Should screening discover that a condition requiring dental treatment, the state is obliged to organize the necessary services to adequately treat the condition that has been found. This treatment must be provided, regardless of whether the services are part of the state’s Medicaid plan or not.

People aged 21 years or over
As part of the Medicaid program, individual states may decide whether to provide dental Medicaid services to their eligible adult Medicaid population. It is also possible for the individual states to decide not to offer dental services as part of the Medicaid program. Today the majority of states provide elementary emergency dental services for adults. Fewer than half the states provide a full dental care service. Adult dental coverage is not a mandatory requirement for the states.

How does it work?
Medicaid requires that the medical assistance program of the individual states is available to cover half of the associated payments. Thanks to the recession, that has led to funding crises. Even critical health programs have been put at risk of cancellation of some services. By January 2009 it had been reported that less than 50% of states offer complete dental care coverage and assistance.

Medicaid dental services for children provide comprehensive coverage and are required by law. The services included are diagnosis treatment and early screening. However, the elderly often find it extremely difficult to get dental services, and anyone who is aged 21 or more may or may not have access to Medicaid services, dependent upon the position of the state in which they live.

How and where to apply?
States are under no obligation to provide even a partial dental care Medicaid service to the eligible adults in its population. No minimum requirement exists for dental treatment for adults. However, at least most of the states offer a minimal emergency dental treatment service.

If you want to apply for Medicaid coverage you should apply to the state in which you live. Often you can apply for Medicaid online, visiting the appropriate offices in your community or by phone. In order to understand what your state is able to offer you, contact the Medicaid office nearest to you or find information on the internet.

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