There is a common misconception that dental care and hygiene are less important than general health and medical needs. However, having a clean bill of dental health is a vital part of overall health and wellbeing.
This misconception of the importance of dental care has led healthcare programs, including Medicaid, to have a separation between general benefits and adult dental benefits. Instead of incorporating dental into the physical health coverage, it is added as a bonus or not at all.
If you have been wondering if your state of residence’s Medicaid program has dental benefits included, read on to find out what is available in your state. If you live in a place without Medicaid dental care, there are also resources included in this article to give you the tools to take care of all aspects of your health.
Quick Navigation Links
- How Does Medicaid Dental Coverage Work?
- How Can I Find A Dentist Accepting Medicaid?
- Final Takeaways
How does Medicaid Dental Coverage Work?
In all of the United States, each state is required to have a Medicaid program that meets mandatory criteria set by the federal government. In all of the states, these minimum requirements do not include dental for adults, only for those who are under the age of 21.
However, after the passing of the Affordable Care Act, states can now extend those original benefits to offer more healthcare to a larger group of its residents. Many extensions include at least some adult dental coverage, and some even have full coverage. However, there are a few states which have no adult dental benefits added to their Medicaid program.
Depending on your state of residence, the type of care available to you is one of the following: none, emergency, limited, and comprehensive.
Which States Have No Adult Dental Coverage?
Only a small number of states have no dental coverage whatsoever. If you live in the following states and need dental care, you will have to do so outside of Medicaid benefits.
States with no adult dental benefits:
If your state of residence is one of these four, then any dental care will not be covered by Medicaid. This can be very alarming to hear since out-of-pocket dental expenses can be incredibly high.
Resources For Those Without Dental Coverage
However, there are still ways to get affordable dental care without Medicaid. Here are some options that may be available to you:
- If you are 65 or older and are enrolled in a Medicare Part C program, there is a good chance that you have dental coverage through this program. Talk to a program coordinator and find out if you are covered.
- Find the nearest dental school. Every state has a university that includes a dental program. This is one of the most competitive programs to get into, so even a student dentist will be very capable of your care.
- Get in touch with your local 211. The specialists on the other end will be able to direct you to dental clinics that offer affordable care.
- If you are 65 and over, disabled, or otherwise medically vulnerable, you can apply for free dental care through Dental Lifeline. This is a service that dentists and dental professionals provide donated dental care. Dental Lifeline operates in every state.
Which States Have Emergency Adult Dental Coverage?
There are situations where the need for dental care becomes an emergency. Infections of the mouth can be very dangerous due to the proximity to the brain.
What counts as a dental emergency can vary from state to state. If it is life-threatening or requires surgery, then it is an emergency. Severe and acute pain is probably an emergency, so you can probably get extractions if needed as well.
If you aren’t sure if you are in an emergency, your best course of action is to call a dentist or have someone call for you. They will be able to advise on the situation.
States with only emergency adult dental:
- New Hampshire
Which States Have Limited Adult Dental Coverage?
When Medicaid has limited coverage for dental, this usually means one of two things. Either there is a financial cap to the dental care you can have covered, or there is a fixed list of services that will be covered.
If it is a financial cap, the range is usually somewhere between $500 to $1000. Once that amount is met, dental won’t be covered unless it is an emergency.
If it is a fixed list, your Medicaid dental benefits will typically include preventative care such as cleanings and restorative care such as fillings, as well as emergency care.
States with limited adult dental care:
- South Carolina
- South Dakota
States with Comprehensive Adult Dental Care
States where Medicaid offers comprehensive care will have more services covered than services not covered or a higher financial cap.
In addition to emergency care, there are benefits for restorative, preventative, and diagnostic services for those enrolled in Medicaid.
States with comprehensive adult dental care:
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
- Wisconsin (through BadgerCare)
Something that is not typically covered even in comprehensive plans is adult orthodontic care or braces. If this is something that you require, you may need to pay out-of-pocket. Luckily, this is not something that would be an emergency, so you will still have all the care that you need to maintain good dental health.
How Can I Find A Dentist Accepting Medicaid?
Not all dentists take Medicaid patients, so you need to find a dentist that accepts your dental coverage. You can phone around or ask your doctor for a referral if you have specific dentists in mind.
If you aren’t hoping to see a specific dentist and are open to new care options, DentaQuest is a great resource. All you need is your city name and Medicaid ID card, and the website can give you a complete list of all the dentists in your area that accept Medicaid. They will also contact the clinic on your behalf in the case of a conflict.
Since Medicaid is administered through each state individually, the benefits can vary significantly between states, and dental benefits are where you see the most variation.
This article was meant to provide all the information required to know what adult benefit you have through Medicaid and provide resources for those with little or no dental coverage. Dental health is a core component of a healthy body, so be sure to take the next steps needed to maintain your health and wellness.