Dental Services for Adults
Medicaid is a joint and voluntary program between the federal government and the states, with the mission to provide health insurance coverage to low-income individuals throughout the country. States have flexibility to determine what dental benefits are provided to adult Medicaid enrollees. Currently, there are no minimum requirements for adult dental coverage. According to a 2016 issue brief from the Kaiser Commission on Medicaid and the Uninsured, 15 states provide comprehensive dental benefits, while 13 states provide emergency-only dental benefits.
Dental Services for Children
Medicaid covers dental services for all child enrollees as part of a comprehensive set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Though oral screening may be part of a physical exam, it does not substitute for a dental examination performed by a dentist. A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state. Dental services for children must minimally include: relief of pain and infections; restoration of teeth; and maintenance of dental health. In addition, the EPSDT benefit requires that all services must be provided if determined medically necessary. States determine medical necessity.
2016 American Dental Education Association (ADEA), 655 K Street, NW, Suite 800, Washington, DC 20001 (202) 289-7201