If you are on Medicaid or have a loved one on it, it’s smart to understand the dental coverage you get. After all, dental care is crucial to your overall health.
Children Are Covered
No matter what state you live in, children have dental coverage under Medicaid in combination with the Children’s Health Insurance Program (CHIP). The comprehensive dental benefits for children on Medicaid are called Early and Periodic Screening, Diagnostic, and Treatment (EPSDT).
Children on Medicaid must get a referral to a dentist. At the very least, Medicaid has to cover the following for kids:
- Dental health maintenance
- Tooth restoration
- Relief of infections and pain
States determine if a treatment is medically necessary. If so, then the state must provide it.
CHIP can be part of a Medicaid expansion plan or a separate program. If it’s included, the state has to offer EPSDT benefits. If separate, states can offer dental coverage via a benchmark dental benefit package or a package of benefits that meet the requirements of CHIP.
It Varies by State for Adults
For adults, the Medicaid dental benefits vary by the state since states get to decide on this matter. Less than half offer comprehensive dental care, however. Most offer only emergency dental services.
As patients of Dr. Dhiraj Sharma are in Illinois, that’s the most relevant state to look at. Illinois offers extensive dental benefits to adult Medicaid recipients. There are about 1.7 million adults in the state’s Medicaid program. Most of these people get preventative dental coverage via managed-care organizations (MCOs).
These MCOs voluntarily pay dental offices for various preventative services. Those include sealants and cleanings. MCOs haven’t previously been reimbursed but will be in the future.
About 450,000 adult recipients of Medicaid in Illinois don’t get care from MCOs. For these people, dental services weren’t covered until recently. Since 2018, however, preventative dental services have been covered in Illinois.
Children on Medicaid are entitled to dental benefits, including preventative care. States get to decide whether to offer dental benefits to adults, as there isn’t a federal minimum requirement. Illinois is one of the states offering preventative dental care to adults on Medicaid.
Learn more about your options by contacting our dental offices in Chicago today!