Medicaid 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.
Dental Benefits for Children in Medicaid
Medicaid covers dental services for all enrolled children as part of a comprehensive set of benefits. 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 include:
- Relief of pain and infections
- Restoration of teeth
- Maintenance of dental health
Dental services must be provided at intervals that meet reasonable standards of dental practice, and at such other intervals, as indicated by medical necessity. States must consult with recognized dental organizations involved in child health care to establish those intervals. States are also required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages
Dental Benefits for Adults in Medicaid
States have flexibility to determine what dental benefits are provided to adults enrolled in Medicaid. 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.
