Healthcare Members with Standard Medicaid Benefits are eligible for almost all dental and denturist services when they are medically necessary for members under age 21 and some members age 21 and over. Some services are only available to members age 20 and under. Pregnant women who present a Presumptive Eligibility Notice of Decision are eligible for dental services, as well.
Beginning July 1, 2016, all members with Standard Medicaid Benefits will have an annual $1,125 dental treatment services cap; excluding covered diagnostic, preventative, denture, and anesthesia services. Periodic service limits apply. It is important to note the following exclusions from the annual dental treatment services cap: Children age 0-20 and Adults determined categorically eligible for Aged, Blind, and Disabled Medicaid (current Medicaid, not HELP).
Covered Dental Services
Diagnostic - Preventative - Basic Restorative (including prefabricated stainless steel crowns) - Dentures (immediate, full and partial) - Extraction Services
Porcelain/ceramic crowns - noble metal crowns and bridges are not covered for members 21 years of age and older - No-show appointments - Cosmetic dentistry - Splints/mouthguards (age 21 and over) - Qualified Medicare Beneficiary (QMB) - Dental Implants
Members age 20 and under
Dentures for adults
- Can get dental exams and cleanings as often as necessary
- Should visit a dentist by their first birthday, and then at least once every six months after the first tooth comes in
- During a Well Child Checkup, doctors should do an oral exam, including the application of fluoride varnish if needed
- Bridges and tooth-colored crowns are available
- Find a Children's (20 and under) Dental Provider
- $1,125 annual cap for treatment services
- Can have dental exams and cleanings every six months
- Can get two porcelain fused to base metal crowns per calendar year
- Dentures are covered for adults
- Partial dentures may be replaced if the dentures are 5 years old or older
- Full dentures may be replaced if the dentures are 10 years old or older
- One lost pair of dentures in a person's life time is covered
Work with your dental provider to ensure your services are a covered benefit.
Find a Medicaid Dental Provider