Does Medicaid Cover Dental Care?
Key takeaways:
Medicaid provides comprehensive dental benefits for children, but coverage for adults is less common and may be subject to limitations.
There are currently more than 25 state Medicaid programs, including Washington, D.C., that offer extensive or comprehensive adult dental care for preventive and diagnostic procedures.
Some states, such as Georgia, and Texas, offer coverage for emergency-only dental care, such as treating infections or severe tooth pain, for adults on Medicaid.
Dental care costs can pose a significant financial challenge for many Americans. A Kaiser Family Foundation poll found that nearly 50% of U.S. adults put off or avoid dental services due to cost.
If you meet the income requirements, you or your family may qualify to receive dental benefits through Medicaid. State programs offer comprehensive benefits to children and young adults, but dental care for adults 21 and older is optional. Medicaid provides healthcare coverage to eligible individuals and families for free or at a low cost.
Does Medicaid cover dental care for adults?
Medicaid dental coverage for adults is optional and varies from state to state. Medicaid does not set any required minimum amount of dental benefits for adults. However, 49 states and Washington, D.C. offer at least some dental coverage for adult recipients at this time.
Prescription Savings Are Just the Beginning
See what other benefits you qualify for—from cashback cards to cheaper insurance.
If your dental procedure is considered cosmetic or experimental in nature, Medicaid most likely won’t cover it. Dental care must be considered preventive or medically necessary for dental health. It’s important to contact your state Medicaid office to determine which services will be covered and if there are any limits you should be aware of.
Extensive coverage
More than 25 states, including Washington, D.C., offer extensive or comprehensive adult dental care. According to the American Dental Association, extensive care covers over 100 preventive and diagnostic procedures. That includes minor and major services costing at least $1,000 per person. The following states offer extensive adult dental coverage through Medicaid:
Alaska
California
Colorado
Connecticut
Idaho
Illinois
Iowa
Maine
Massachusetts
Montana
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Rhode Island
South Dakota
Vermont
Washington, D.C.
Washington state
West Virginia
Wisconsin
Limited coverage
There are more than 10 states offering limited adult dental coverage. Limited coverage means Medicaid covers less than 100 services. These can range from routine check-ups, cleanings, and fillings to minor dental repairs. The benefits are capped at $1,000 per person annually. States with limited coverage include:
Arkansas
Delaware
Indiana
Kansas
Kentucky
Louisiana
Minnesota
Mississippi
Missouri
Nebraska
Pennsylvania
South Carolina
Wyoming
Emergency coverage
A few states offer emergency-only dental care for adults on Medicaid. That means they only cover urgent dental situations, such as treating infections or severe tooth pain. These states include:
Read more like this
Explore these related articles, suggested for readers like you.
Typically, anyone 21 and older will qualify for emergency dental services in most states. Currently, all states, including Texas and Utah, provide dental services for adults during pregnancy. As of October 2022, Alabama provides dental benefits to Medicaid recipients over 21 during pregnancy and postpartum as long as the services are provided by Medicaid-enrolled dental providers.
It's wise to check the program in your state to see which adult dental services Medicaid covers.
Does Medicaid cover dental care for children?
Yes, it's federal law. All states must provide dental services to children and young adults under age 21. That includes anyone enrolled in Medicaid and the Children's Health Insurance Program (CHIP). This dental benefit is part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) initiative. The program works by checking for problems early and treating them quickly. Every state must include EPSDT in its Medicaid program.
As a rule, all dental coverage for children must include treatment related to:
Maintaining dental health
Relieving pain and infections
Restoring teeth
Treating emergency conditions
In addition, Medicaid dental benefits for children may cover preventative services like:
Checkups
Cleanings
Sealants
Other Medicaid benefits for children may also include restorative services like:
Emergency procedures
Fillings
If a problem is noted during a dental screening, states must provide the necessary care to treat it — even if it's not typically covered. Medicaid also requires that children see a dentist regularly. The state determines the frequency, but the time between visits must be reasonable.
Do all states provide dental coverage?
Yes. All 50 states and Washington, D.C. provide at least some dental services through Medicaid. Typically, recipients under 21 will receive full dental benefits in every state. However, each state has the power to decide how much dental care, if any, they will offer to adults on Medicaid.
How to use Medicaid for dental care
Here's how you can get dental care through Medicaid:
Check your state's Medicaid website to determine which dental services are covered.
Find a dentist who accepts Medicaid. You can call your Medicaid plan or visit the Medicaid website.
Make an appointment with the dentist.
Bring your Medicaid ID card and any other required documents to your appointment.
Your dentist will provide services, and Medicaid will cover the cost.
Who qualifies for Medicaid?
The Affordable Care Act changed how people can qualify for Medicaid. This may help you become eligible for Medicaid based solely on your income. There is also only one application for all Medicaid programs. That makes it easier to apply and sign up for the right program.
To qualify for Medicaid, you must meet state and federal requirements:
Be a U.S. citizen or a legal resident with a valid immigration status
Have an income at or below the federal poverty level
Fall into an eligible category, such as being pregnant, having a disability, or being a child or an adult caring for a child
Live in the state where you're applying for Medicaid
Also, keep in mind that income requirements can change from year to year.
In general, you can sign up for Medicaid in two ways:
Through the health insurance marketplace
Directly through your state Medicaid agency
You can also go to HealthCare.gov, take a short quiz, and see if you qualify for Medicaid or other health insurance options.
From January 2020 to March 2023, people with Medicaid could keep their benefits without having their eligibility reviewed. This was due to the COVID public health emergency. But as of April 2023, individuals must again show proof of eligibility. This is known as Medicaid unwinding.
Dental care resources for those without insurance
For each adult without health insurance, there are three without dental insurance. Adults without dental insurance might have a hard time accessing dental care.
However, there are many ways you can still save money on dental care even if you don’t have insurance:
Buy a dental savings plan. Research dental savings plans online and explore the benefits. You get a discount card and pay a discounted rate for services from a network of dentists.
Check out community health centers. To find a clinic near you, check the HRSA Data Clearinghouse or contact your local health department.
Try negotiating. You may be able to lower your dental bill just by asking, or you can also request a payment plan.
Use your health savings account. You own your HSA even if you no longer have insurance. To use your HSA without paying a penalty, your dental treatments must fall under the IRS criteria for qualified medical and dental expenses.
Visit a dental school. Dental students, who are supervised by a faculty dentist, can cost up to 50% less depending on where you live and the clinic you visit.
The bottom line
Medicaid programs provide affordable dental care for individuals with low income. Dental care benefits are mandatory for people under 21 but optional for adults. Most states provide extensive coverage for all Medicaid recipients. But a few only offer emergency dental services for adult members. Even if you don't have insurance, you can still save money on dental services. Resources like dental savings plans or community health centers may help lower costs.
Why trust our experts?
References
Alabama Medicaid. (n.d.). Dental program.
Arizona Health Care Cost Containment System. (2021). Emergency dental benefits 21+.
Centers for Disease Control and Prevention. (2020). Adult oral health.
DentaQuest. (n.d.). Children's Medicaid dental benefits.
Department of Health and Human Services. (n.d.). Nevada Medicaid – Recipient’s dental FAQs.
Department of Health and Human Services. (n.d.). Provider dental FAQs.
Florida Agency for Health Care Administration. (n.d.). Florida Medicaid’s covered services and HCBS waivers: Dental services.
Georgia Department of Audits and Accounts. (2021). Medicaid dental.
HealthCare.gov. (n.d.). Federal poverty level (FPL).
Internal Revenue Service. (2023). Publication 502 (2022), medical and dental expenses.
Maryland Department of Health. (n.d.). Maryland Healthy Smiles messaging for providers.
Medicaid.gov. (n.d.). Contact us.
Medicaid.gov. (n.d.). Dental care.
Medicaid.gov. (n.d.). Early and periodic screening, diagnostic, and treatment.
Medicaid.gov. (n.d.). Medicaid and CHIP: How-to information.
Medicaid.gov. (n.d.). Medicaid eligibility.
Michigan Department of Health and Human Services. (2023). MDHHS expands dental benefits for Medicaid beneficiaries.
Montero, A., et al. (2022). Americans’ challenges with health care costs. Kaiser Family Foundation.
National Academy for State Health Policy. (2022). State Medicaid coverage of dental services for general adult and pregnant populations.
New Hampshire Department of Health and Human Services. (2023). NH DHHS announces launch of Medicaid dental coverage for adults on April 1.
State of Hawai’i Department of Human Services, Med-QUEST Division. (n.d.). Additional covered benefits.
U.S. Department of Health and Human Services. (2022). Does Medicaid cover dental care?
Utah Medical Benefits. (n.d.). Dental benefits: Traditional Medicaid.
Virginia Department of Health. (2021). Implementation of adult dental services, effective July 1, 2021.
Vujicic, M., et al. (2021). Making the case for dental coverage for adults in all state Medicaid programs. American Dental Association Health Policy Institute, Families USA, and Community Catalyst.
