Medicaid Dental Coverage: What You Need to Know

Medicaid is a federal/state program that provides health insurance to eligible individuals. Dental services are included in the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit program but is not available to all eligible Medicaid recipients.

Medicaid Recipients Age 21 and Under

• The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit is a comprehensive program for individuals 21 years of age and under. The focus is on preventative dentistry, early diagnosis of medical conditions and treatment of those conditions. Dental services are required to be provided to these Medicaid-eligible individuals as a part of this benefit.

Medical Necessity

• During a dental screening, if a condition is uncovered, the state is required to provide the eligible individual with the medical treatment needed if determined a medical necessity through the EPSDT program under Medicaid. This stands true even if the services are not covered by Medicaid in that state.

Medicaid Recipients Over 21 Years of Age

• Each state decides whether or not dental services are to be provided to eligible adults under Medicaid. Most states offer emergency dental services but many states do not provide any medical care to individuals over the age of 21.