Does Medicaid Cover Children’s Dental?

Does Medicaid Cover Children’s Dental?

You already how important dental health is when it comes to your overall health and that establishing good habits when children are young helps keep them healthy as they grow. So, when it comes to ensuring your child gets the dental care they need and that you can afford it, states are required to provide dental benefits to children through the Medicaid and the Children’s Health Insurance Program (CHIP). The big difference is that states can determine for themselves if they want to cover dental care for adults.

For children, Medicaid covers dental services. The full set of benefits is referred to as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. A physician may be able to offer an oral screening when they perform an overall physical exam, but a separate and specific dental exam must be completed by a dentist. In order to first make the appointment, you must first have a referral to a dentist that abides by the periodicity schedule of that state.

The minimum dental services that are covered by Medicaid must include:

  • Maintaining dental health
  • Restoring teeth
  • Relieving pain
  • Addressing infections

Additionally, the Early and Periodic Screening, Diagnostic and Treatment benefit ensures that Medicaid covers any dental service that is deemed medically necessary. If a dentist should discover a condition or disease during a screening, then Medicaid must cover the necessary treatment for that condition or disease. The dental coverage must extend beyond just emergency dental care.

The goal of the Medicaid coverage for children’s dental care is to ensure that the child is able to be screened for future problems, treat current problems, and prevent potential future issues. Each state works with recognized dental organizations to determine the appropriate intervals for dental services. Dental services needed between these visits are also covered, as long as they are deemed medically necessary.

If your child is covered through a Medicaid expansion program, the minimum coverage for the child must be no less than the Early and Periodic Screening, Diagnostic and Treatment benefit. For the states that have a separate CHIP, they can provide a package that meets Children’s Health Insurance Program requirements. Otherwise, they can use a benchmark dental benefit package that is equal or nearly equal to 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.

It should be easy for you to locate a dental care provider that accepts your child’s Medicaid benefits by locating one on Tooth decay is one of the most common chronic diseases affecting children but by using the Medicaid benefits available to children, it does not have to be for any child in any state. To learn more about the Medicaid benefits available to your child for dental services in your state, you can turn to Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents.

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