The availability of dental care depends on both age and the state you reside in. All states are required to provide dental care for children that are covered by Medicaid and Children’s Health Insurance Program (CHIP).
While states can choose to offer better dental coverage for children on Medicaid, they are required to offer at least maintenance of dental health, restoration of teeth, and relief of pain and infections. The comprehensive list of health benefits for children is referred to as the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit, and these benefits cover dental healthcare requirements.
|Early||Assessing and identifying problems early through regular screenings starting at a young age to catch problems before they develop|
|Periodic||Covering dental exams at regular and age-appropriate intervals. This typically means ever six months.|
|Screening||Screening tests to identify potential dental problems including regular x-rays|
|Diagnostic||Diagnostic tests to follow up as needed when potential risks are identified|
|Treatment||Eliminate, reduce, and correct dental health problems that are identified|
In states where CHIP coverage is provided, the EPSDT benefits must still be offered. However, CHIP takes the dental care of children a step further. Separate CHIP programs are required to cover any and all dental services “necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.” Under such a broad definition, nearly any dental service or procedure may be covered for children under CHIP.
Check Your Eligibility
States with separate CHIP programs have two options. They can offer a dental benefits package that meets all the requirements laid out for CHIP under federal regulations, or they can offer a benchmark dental package. The benchmark package is one that is equivalent to the dental plan offered to the dependents of federal employees, the plan offered the dependents of state employees, or a dental plan that is equal to the most popular plan offered by a commercial insurance company within the state.
These plans are set as a minimum standard of what should be provided, so the children on CHIP are getting dental care equivalent to other insured children in the state. States will post a list of their dental packages and providers for their Medicaid and CHIP programs on their state Medicaid website, which is where you can find them.
Despite the clear regulations regarding dental care for children, states are not required to offer dental coverage for adults receiving Medicaid. Less than half the states offer comprehensive dental coverage for adults. However, most states will cover emergency dental services under their emergency care package. Dental care packages for adults can be purchased through the Marketplace, and the cost will be dependent on your estimated income.
For both children and adults, eligibility for dental coverage is determined by their eligibility for Medicaid or CHIP coverage. You do not need to apply for dental coverage separately. If you are eligible for Medicaid, you will be eligible for dental services that go along with the state’s Medicaid program.