Dental Benefits For Children In Medicaid
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 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
- Maintenance of dental health
The EPSDT benefit requires that all services must be provided if determined medically necessary. States determine medical necessity. If a condition requiring treatment is discovered during a screening, the state must provide the necessary services to treat that condition, whether or not such services are included in a state’s Medicaid plan.
Each state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health care. Dental services may not be limited to emergency services for children entitled to EPSDT.
How Do I Find Low
To find dental clinics for low-income families or individuals:
- Contact your local health department
- Contact a local dental school
- Participate in a clinical study
- Contact a Health Insurance Navigator
And to find dentists and dental clinics that accept Medicaid:
- Consult the provider booklet that came with your insurance to find Medicaid dental offices
Does Pregnancy Medicaid Cover Dental
Although pregnant women enrolled in Medicaid and CHIP are entitled to ?pregnancy-related services,? dental care is not explicitly included as a pregnancy-related service, and federal Medicaid law leaves dental care for adult enrollees as a state option.3 CHIP requires coverage of dental care for youth, including
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Does Medicaid Cover Dental Care In North Carolina
Keeping up on oral care is a critical piece of maintaining your overall health. It is advised to visit the dentist twice a year for a checkup to ensure your teeth are healthy and clean and that you dont have any cavities, tooth decay, or other oral health issues, including gum disease, cancer, and more. While highly important, dental care can be quite costly, and many people carry dental insurance to help cover the bills. Medicaid is a common health insurance used by millions of people across the United States. Depending on your residency status in North Carolina and the dental care you require, Medicaid services may provide coverage for your dental needs.
What Type of Dental Care is Commonly Provided?
Dental needs can vary widely from person to person. One of the most common procedures done is a routine cleaning. This involves removing the plaque and tartar that builds up on, around, and between the teeth and gums. These cleanings can also help to remove any stains that have become apparent on the teeth and create a protective coating on the teeth to better shield them from damage by bacteria.
Some other common dental procedures include root canals, which involve removing and replacing the center core of the tooth sealing the surface of the teeth to create a barrier to bacteria teeth whitening procedures fittings for dentures, which can include just a few fake teeth or serve as a full new set and more.
Does Ga Medicaid Cover Pregnancy
Medicaid for Pregnant Women pays for medical care for pregnant women, including labor and delivery, for up to 60 days after giving birth. Children who qualify are entitled to the full-range of Medicaid covered services including doctors visits, health checkups, immunizations, dental and vision care.
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Children’s Oral Health Initiative
The Centers for Medicare & Medicaid Services is committed to improving access to dental and oral health services for children enrolled in Medicaid and CHIP. We have been making considerable progress in our efforts to ensure that low-income children have access to oral health care. From 2007 to 2011, almost half of all states achieved at least a ten percentage point increase in the proportion of children enrolled in Medicaid and CHIP that received a preventive dental service during the reporting year. Yet, tooth decay remains one of the most common chronic childhood diseases.
To support continued progress, in 2010 CMS launched the Children’s Oral Health Initiative and set goals for improvement by FFY 2015. To achieve those goals, we have adopted a national oral health strategy through which we are working diligently with states and federal partners, as well as the dental provider community, children’s advocates and other stakeholders to improve children’s access to dental care.
To support state Medicaid and CHIP programs in achieving their improvement goals, we developed Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents . It provides an overview of the children’s dental benefit in Medicaid, support for evidence-based policies at the state level, and details of successful strategies with state examples.
Dental Benefits For Children In Chip
States that provide CHIP coverage to children through a Medicaid expansion program are required to provide the EPSDT benefit. Dental coverage in separate CHIP programs is required to include coverage for dental services “necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.”
States with a program may choose from two options for providing dental coverage: a package of dental benefits that meets the CHIP requirements, or a benchmark dental benefit package. The benchmark dental package must be substantially equal to the the most popular federal employee dental plan for dependents, the most popular plan selected for dependents in the state’s employee dental plan, or dental coverage offered through the most popular commercial insurer in the state.
States are also required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages on InsureKidsNow.gov.
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How To Apply For Medicaid
Because Medicaid is administered through the state and states determine eligibility, you will need to visit your states Medicaid office or website to apply. When applying you will need proof of income, residency, age, citizenship and/or immigration status for every member of your household.
Contact your state Medicaid office . Getting approved for Medicaid can take time, so start the application process as soon as there is a clear need. Most offices allow you to apply or at least start your request online. You may need to go into one of their offices for an interview as part of the application process. Have all your needed verification documents ready.
Medicaids Eligibility factors include income, residency, age, citizenship, immigration status, household composition, and pregnancy.
The exact verification documents you will need will vary based on what state you are in. However, be prepared to have any proof of income, proof of residency, your social security card, and immigration status confirmation documents on hand . Generally, household composition and pregnancy status do not require formal verification.
Upcoming Changes To Dental Services In Florida Medicaid
In 2016, the Florida Legislature directed the Agency for Health Care Administration to enroll most Medicaid recipients into dental plans. Recipients will receive a dental plan based on the below schedule. The schedule is separated into phases by the recipients county location.
Recipients will begin to receive letters soon. They will be mailed out about 45 days before each phase starts. For example, recipients will begin to receive letters for Phase 1 in the middle of October. For more information, please click on the following link:
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Medicaid Benefits Many Women
Medicaid insurance is of benefit to many women in financial need during pregnancy. Even if you were not eligible before, you may become eligible once you are pregnant. At the least, all your pregnancy-related medical care will be covered and depending on which state you reside in, you may qualify for medical care not related to your pregnancy.
Virginias Medicaid Expands Now Covers Dental And Prenatal Services
NEW RIVER VALLEY, Va. Virginias Medicaid has now expanded to include dental benefits and prenatal services.
Before the recent expansion, Virginias Medicaid dental benefits were only available for children and teens, but they now include adults.
Adults thats enrolled in Medicaid ages 19 to 64 would now be eligible for dental benefits, and that would include things like preventative care, dentures, fillings, cleanings and many more benefits root canals included as well, said Amber Poron, a Navigator Outreach Coordinator for Virginia Poverty Law Center.
New and current enrollees will be able to access full dental services including X-Rays, exams, root canals, oral surgeries and more.
So its really very important because a lot of people have gone several years without getting the dental care thats needed, and your dental care can affect your overall health, said Poron.
Leaders from Virginias Poverty Law Center also say this decision to expand these services is historic and may result in thousands more Virginians enrolling in Medicaid.
The majority of people are interested in getting care for their teeth done, so I feel like this might be the deciding factor for some people that have not wanted to enroll in Medicaid. And now theyre able to get the dental benefits and maybe that will make it worth it for them, said Poron.
The prenatal benefits will also continue 60 days post-partum.
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Dental Benefits For Adults In Medicaid
States have flexibility to determine what dental benefits are provided to adult Medicaid enrollees. While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. There are no minimum requirements for adult dental coverage.
What Does Medicaid Cover
Medicaid is a social insurance program administered by state and federal governments designed to cover the basic healthcare needs of lower income families in America. This means that Medicaid helps people with low incomes cover their health care costs. But what does Medicaid cover for you? And are you eligible for Medicaid in your state?
To qualify for Medicaid coverage, a person must make less than 133 percent of the federal poverty line, which is about $16,000 for an individual or about $32,000 for a family of four.
In recent years, Medicaid enrollment has surged across the U.S. and now, along with the companion Childrens Health Insurance Program program, cover more than 74 million people.
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Is It Ok To Have Dental Work While Pregnant
Dental work while pregnant, such as cavity fillings and crowns, should be treated to reduce the chance of infection. If dental work is done during pregnancy, the second trimester is ideal. It is best to avoid this dental work while pregnant and avoid exposing the developing baby to any risks, even if they are minimal.
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Is A Woman Who Has Access To A Family Members Employer
Possibly. If the employer-sponsored insurance is unaffordable or not MEC, the woman is eligible for APTCs. Affordability is determined by the IRS standards for the percentage of income a person is expected to spend on insurance. This calculation applies to the cost of the employees insurance, not the cost of the family plan. That means that if the premiums for the employees insurance are affordable, no member of the family is eligible for an APTC. If the individuals premium is unaffordable, the family will be eligible for APTCs in an amount determined by their income and the premium cost.
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Dental Care During Pregnancy
During pregnancy women are at a higher risk of developing periodontal disease. Periodontal disease affects the gums and it can be associated with low birth weight and/or preterm birth. The National Institute for Health Care Management reports that, pre-term birth rate was 42% higher for babies birthed by women who did not receive dental care during pregnancy and low birth weight was 33% higher.
It is recommended that pregnant women receive a routine dental examination because the mouth is affected by hormonal changes. According to research, women can visit the dentist at any time during pregnancy. The American Congress of Obstetricians and Gynecologists reports, it is recommended that OB/Gyns make an oral health inquiry during the first prenatal visit. Research published by the American Dental Association states that, poor habits during pregnancy have been associated with premature delivery, intrauterine growth restriction, gestational diabetes and pre-eclampsia.
Some pregnant women can develop gum disease causing swelling, tenderness, and bleeding to the gum area. Research has suggested that bacteria causes inflammation in the gums and can get into the bloodstream targeting the fetus, possibly leading to premature or low- birth weight babies. Overall, scheduling routine dental visits will benefit both mother and baby.
Types Of Medicaid Plans Including Dental
The type of Medicaid that you have could impact whether it pays for dental work for adults. Each state offers a variety of plans designed for different groups of low-income individuals.
In addition to the straight or regular program, you could enroll in unique plans for pregnant women, dual-eligible Medicare recipients, and individuals deemed medically needy.
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Does Tennessee Have Expanded Medicaid
More than 1.3 million people are enrolled in Tennessees Medicaid program, known as TennCare, and the state is one of 14 that has not joined Obamacares Medicaid expansion for low-income adults. The federal government on average covers about two-thirds of Medicaid costs in Tennessee, with the state covering the rest.
Cms Learning Lab: Improving Oral Health Through Access
The Center for Medicaid and CHIP Services at the Centers for Medicare & Medicaid Services is hosting a series of webinars to support States and their collaborative partners to improve access to dental services for children enrolled in Medicaid and CHIP. The webinar materials are available below. For more information about the CMS Oral Health Initiative and the CMS Learning Lab webinars, see the .
Reducing Early Childhood Tooth Decay: Approaches in Medicaid May 27, 2015
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Does Medicaid Cover Braces Overview
The answer is yes, well, sort of. Medicaid will pay for your braces but only if these devices are deemed a medical necessity by an approved physician. Medicaid also considers your age, the state you reside in, and why you want to straighten your teeth.
Even if an orthodontist recommends that Medicaid pay for your braces, you will still need approval from youre local Medicaid office.
This is because Medicaid is provided on a state-by-state basis, so decisions on what will and what wont be covered vary by quite a lot.
However, if your income isnt as high, you can take advantage of Medicaids coverage for braces because the standards that apply to you will be relaxed.
Some states also have special provisions for children who come from low-income families.
Coverage is hard to come by even if braces are medically necessary, even for children. Also, if youre looking to get Medicaid to pay for aesthetic braces you will be disappointed.
Individuals Under Age 21
EPSDT is Medicaid’s comprehensive child health program. The program’s focus is on prevention, early diagnosis, and treatment of medical conditions. EPSDT is a mandatory service required to be provided under a state’s Medicaid program.
Dental services must be provided at intervals that meet reasonable standards of dental practice, as determined by the state after consultation with recognized dental organizations involved in child health, and at such other intervals, as indicated by medical necessity, to determine the existence of a suspected illness or condition. Services must include at a minimum, relief of pain and infections, restoration of teeth and maintenance of dental health. Dental services may not be limited to emergency services for EPSDT recipients.
Oral screening may be part of a physical exam, but does not substitute for a dental examination performed by a dentist as a result of a direct referral to a dentist. A direct dental referral is required for every child in accordance with the periodicity schedule set by the state. The Centers for Medicare & Medicaid Services does not further define what specific dental services must be provided, however, EPSDT requires that all services coverable under the Medicaid program must be provided to EPSDT recipients if determined to be medically necessary. Under the Medicaid program, the state determines medical necessity.
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How Can I Enroll In Apple Health
You can enroll in Apple Health at any point during the year on the Washington Healthplan Finder. If you do not qualify for Apple Health, the Washington Healthplan Finder has many other insurance options for you to choose from.
About 7-10 days after applying for Apple Health coverage, a ProviderOne services card will be mailed to you. This is a plastic ID card that looks like other health insurance ID cards. Take this card with you to your doctor and dentist appointments. Providers use this card to make sure your service is covered.
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State Oral Health Action Plans
To support the Oral health Initiative, CMS invited state Medicaid agencies to develop State Oral Health Action Plans as a roadmap to achieving in their goals.
CMS has received SOHAPs from the following 25 states: Alabama , Alaska , Arizona , California, Connecticut, District of Columbia , Delaware , Florida , Maine, , Massachusetts , Michigan , Missouri , Nebraska, New Hampshire , New Jersey , North Dakota , Oklahoma , Pennsylvania , Tennessee , Utah , Vermont , Virginia , Washington and Wyoming . CMS encourages the remaining 29 states to develop and submit their SOHAPs, and CMS stands ready to provide technical assistance to any state that requests it.
SOHAPs may be submitted using either a CMS-developed Oral Health Action Plan Template or a user-friendly template developed by the Medicaid-CHIP State Dental Association. Completed SOHAPs may be submitted to Andrew Snyder, Health Insurance Specialist via email to with a copy to your CMS Regional Office contact. Any questions about the SOHAPs may also be directed to Mr. Snyder.
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