Things You May Not Know About Medicaid Dental Benefits

The Medicaid program is the largest national health insurance initiative for long-term care coverage of Americans. It is an essential support system, especially for those with low income, covering complex and costly medical needs. Medicaid enrollees might be protected against out-of-pocket medical expenses, even if they cannot afford alternate health insurance. It is a structured partnership program between federal and the respective states. These states have the flexibility to decide on certain aspects of the local Medicaid benefits, including covered services and delivery models. The repayment method for physicians and clinics is also a decision of the state. In the state of Texas, a dental clinic called Kyle Parkway Dentistry can be the answer to all your dental care needs.

While it can be quite a time-consuming exercise to go through all the rules and regulations governing the Medicaid program, we try to list a few things that you might not but should know about its dental benefits.

• Adults Don’t Need Medicaid Dental Benefits

47 states including the District of Columbia offer minimum dental benefits through Medicaid for adult patients. The rest of the states don’t even have a provision for adults. Medicaid dental benefits are aimed to improve dental care for the population under 21 years basically.

• Medicaid Dental Benefits Vary By States

State-wise Medicaid dental benefits vary to a large extent. For instance, patients in New Mexico get access to extensive benefits of preventive and special dental treatments whereas, in Arizona, they might only avail emergency benefits alone. 

• Plan Years Change According To States

Medicaid dental benefits are evaluated yearly on the date of enrollment in some states. But for the other parts of the country, these calculations get reset automatically on the same fixed date for every subsequent year. 

1. Dental Benefits May Vary Within States Too

Medicaid coverage policies went through amendments in 2016. As a result, some states do provide extended dental benefits to the original Medicaid population over the newly expanded ones.

• Nationwide Acceptance For Medicaid

Only an approximate average of about 30% of dentists accept Medicaid all over the country. The primary reason for such a low acceptance ratio is due to lesser payouts through Medicaid over private insurance. Most dentists believe it to be as low as half of what private insurance pays for similar procedures. Apart from this, the non-comprehensive nature of Medicaid dental coverage for essential treatments is also concerning for such dentists. 

• Plan Names May Vary For Medicaid Dental Services

Medicaid dental benefits come under different names for different states. However, the important thing to realize is that they are all funded under Medicaid, irrespective of the banner.

How Does Medicaid Benefits Work?

Medicaid is the national public health insurance scheme meant to benefit the less privileged. It directs individual state medical programs to cover at least half of the associated health expenditure for patients. But critical health programs have witnessed reduction or elimination owing to funding crises. More recently, less than half of the total states provide dental care coverage in the country. Medicaid dental care is mandatory for children below the age of 21 by the law. These services need to be provided on a comprehensive basis. However, for the elderly, these services are restrictive and optional in the majority of the states.

Every state has a set periodic schedule for each child that can be availed only on a direct dental referral. As per the schedule, a patient diagnosed with medical needs should be provided with all the services covered under the Medicaid program. An Early Periodic Screening, Diagnostic, and Treatment (EPSDT) is conducted to validate the dental condition of every concerned child. If the oral tests suggest the requirement for any treatment, the state is bound to provide needful services, irrespective of the coverage under the state’s Medicaid plan.

How And Where To Apply For Medicaid Services?

Application for Medicaid benefits has to be done in the state of residence for all individuals. While Medicaid benefits are compulsory for children, states have the option to provide emergency dental services or none to the adults. As such, there are no minimum requirements for availing adult dental care benefits. While most states allow online applications from residents for Medicaid services, few others can be approached over the telephone or by visiting local communities. Local Medicaid offices can guide for available options in their respective states. Resourceful information can also be availed online by visiting the Centers for Medicare and Medicaid Services (CMS).