Good health is important to everyone, but with skyrocketing medical costs and a slumping economy now is harder than ever to pay for good quality Health Care. If you can't afford to pay for medical care right now, Medicaid can help provide the resources necessary to ensure you and your family have a long and healthy life
Medicaid is a state run program for low-income individuals and families. Many groups of people can gain access to Medicaid as long as they meet certain requirements set forth by their State's Medicaid administration. Medicaid requirements can include age, whether or not you are pregnant, disabled, your financial standing or if you are a US citizen.
Dental Services Under Medicaid
October 26, 2011
The Medicaid program is the country’s principal health program for qualified low-income families and individuals. While the state and Federal government jointly fund it, the states manage their own Medicaid program.
As with other health insurance programs, Medicaid coverage has its own limits. This includes guidelines for dental coverage.
According to Title XIX of the Social Security Act, dental services under Medicaid are optional services for adult recipients (age 21 and older).
Most states provide some form of emergency dental services. However, the majority still do not include comprehensive dental care. If you are 21 or over, you must contact your State’s Medicaid office to check if they provide dental services.
For recipients under 21…
Medicaid’s comprehensive child health program is called the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Dental services are a required service under this benefit. Therefore, most Medicaid beneficiaries under the age of 21 will have access to dental services.
Under EPSDT, dental services must be given in intervals that meet the standard dental practice to ensure that your child receives adequate care. The state consults with recognized dental organizations experienced in children’s care so that it can come up with guidelines that meet industry requirements.
At the very least, the general dental services must include the following:
- Relief of pain and infections
- Restoration of teeth
- Maintenance of dental health
Other Notes
The oral screening isn’t a substitute for dental examinations performed by a dentist, although the oral screening may be part of a physical exam. Moreover, a direct dental referral is required for each child receiving EPSDT benefits.
The Centers for Medicare & Medicaid Services (CMS) does not specifically name the dental services that must be included in the program. But the EPSDT mandates that all services covered by Medicaid must be given to any EPSDT recipient if it is deemed a medical necessity. The state will determine medical necessity.