Coverage. Zucker (18-cv-06945) to challenge the New York State Department of Health’s rules preventing Medicaid coverage for replacement dentures within 8 years from initial placement and the ban on Medicaid coverage for dental implants. Dentures may be replaced based upon medical necessity; dentures and partial plates must be prior authorized by the State. Dental health is an important part of people's overall health. Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents (PDF, 578.09 KB), Improving Oral Health Care Delivery in Medicaid and CHIP: A Toolkit for States (PDF, 2.46 MB), Innovative State Practices for the Provision of Dental Services in Medicaid (PDF, 132.55 KB). While most states provide at least emergency dental services for adults, less than half of the states provide comprehensive dental care. Medicaid is the public health insurance program for low-income Americans. Georgia Medicaid Dental Coverage As mentioned, dental benefits are not covered nationally in Medicaid and are optional in-state programs. Adult Dental Coverage This flyer provides an overview of dental services for all adults age 21 and older covered by Washington Apple Health (Medicaid). Coverage starts Jan. 1. 200 Independence Avenue, S.W. For more information about the CMS Oral Health Initiative and the CMS Learning Lab webinars, see the June 2012 Informational Bulletin (PDF, 141.41 KB). To support continued progress, in 2010 CMS launched the Children's Oral Health Initiative and set goals (PDF, 283 KB) for improvement by FFY 2015. Phone: 855-934-9812 2. For additional information on the Arkansas Medicaid Dental Fee for Service program, enrollees can call the assistance line at 501-320-6230. CMS has received SOHAPs from the following 25 states: Alabama (PDF, 107.08 KB), Alaska (PDF, 244.22 KB), Arizona (PDF, 113.69 KB), California, Connecticut, District of Columbia (PDF, 109.51 KB), Delaware (PDF, 200.96 KB), Florida (PDF, 750.87 KB), Maine, Maryland (PDF, 212.48 KB), Massachusetts (PDF, 223.8 KB), Michigan (PDF, 103.42 KB), Missouri (PDF, 343.93 KB), Nebraska, New Hampshire (PDF, 434.96 KB), New Jersey (PDF, 189.37 KB), North Dakota (PDF, 155.74 KB), Oklahoma (PDF, 150.99 KB), Pennsylvania (PDF, 370.38 KB), Tennessee (PDF, 260.59 KB), Utah (PDF, 111.97 KB),  Vermont (PDF, 277.15 KB), Virginia (PDF, 172.7 KB), Washington (PDF, 122.59 KB) and Wyoming (PDF, 104.23 KB). Under the Affordable Care Act (ACA), some states have chosen to expand Medicaid coverage to previously ineligible adults, but the dental coverage varies widely by state. Washington, D.C. 20201 Medicaid and CHIP offer free or low-cost health insurance for kids and teens. Florida Medicaid dental plans pay for dental services. Whether you will have dental coverage under Medicaid depends on if your state has decided to provide that coverage or not. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. State of Georgia government websites and email systems use “” or “” at the end of the address. Overall, dental insurance coverage is much less prevalent than medical insurance in the United States. The periodicity schedule for other EPSDT services may not govern the schedule for dental services. The review process includes conducting research on what other state Medicaid programs and other payers are covering, as well as analysis of the peer-reviewed literature and clinical guidelines for the nominated topic. Dental coverage in separate CHIP programs is required to include coverage for dental services "necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.". Reducing Early Childhood Tooth Decay: Approaches in Medicaid – May 27, 2015, Performance Improvement Projects (PIP) for States and Health Plans - Implementation Considerations – May 20, 2015, Performance Improvement Projects (PIP) for States and Health Plans - Planning Considerations – May 6, 2015, Linking Children with Special Healthcare Needs to Dental Providers – February 18, 2015, Advancing Program Integrity for Medicaid Dental Programs: Federal, State, and Stakeholder Efforts – January 28, 2015, Improving Oral Health Through Access: Building a Partnership between Medicaid and Head Start – September 16, 2014, State Medicaid and CHIP Program Support of Sustainable Oral Health Care Delivery Models in Schools and Community-Based Settings – May 14, 2014, Keep Kids Smiling:  Promoting Oral Health Through the Medicaid Benefit for Children & Adolescents - January 30, 2014, Dental Sealants: An Effective State Strategy to Prevent Dental Caries in Children - September 19, 2013, Engaging More General Dentists to Care for Young Children: Access to Baby and Child Dentistry (ABCD) in Washington and South Dakota - May 8, 2013, Quality Improvement Processes: An Introduction for Medicaid and CHIP Dental Programs - January 23, 2013, Successful Beneficiary Outreach Strategies - September 26, 2012, Developing State Oral Health Action Plan Using State Data - June 19, 2012, A federal government managed website by theCenters for Medicare & Medicaid Services.7500 Security Boulevard Baltimore, MD 21244, Medicaid Beneficiaries with Complex Care Needs and High Costs, Community Integration Through Long-Term Services and Supports, Using Section 1115 Demonstrations for Disaster Response, Home & Community-Based Services in Public Health Emergencies, Medicaid and CHIP Eligibility & Enrollment Webinars, Affordable Care Act Program Integrity Provisions, Lawfully Residing Immigrant Children & Pregnant Women, Home & Community Based Services Authorities, July 2020 Medicaid & CHIP Enrollment Data Highlights, Medicaid Enrollment Data Collected Through MBES, Performance Indicator Technical Assistance, 1115 Demonstration Monitoring & Evaluation, 1115 Substance Use Disorder Demonstrations, Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations, Seniors & Medicare and Medicaid Enrollees, Medicaid Third Party Liability & Coordination of Benefits, Medicaid Eligibility Quality Control Program, State Expenditure Reporting for Medicaid & CHIP, Actuarial Report on the Financial Outlook for Medicaid, Section 223 Demonstration Program to Improve Community Mental Health Services, Medicaid Information Technology Architecture, Medicaid Enterprise Certification Toolkit, Medicaid Eligibility & Enrollment Toolkit, SUPPORT Act Innovative State Initiatives and Strategies, SUPPORT Act Provider Capacity Demonstration, Learn How to Report the CMS 416 Dental Data, Early and Periodic Screening, Diagnostic, and Treatment, Vision and Hearing Screening Services for Children and Adolescents, Alternatives to Psychiatric Residential Treatment Facilities Demonstration, Testing Experience & Functional Tools demonstration, Medicaid MAGI & CHIP Application Processing Time, Dental Excerpt from the 2015 Secretary's Report, Medicaid Dental Trends Analysis: 2000-2012, Improving Oral Health Care Delivery in Medicaid and CHIP: A Toolkit for States, Federal Policy Guidance-Dental Coverage in CHIP, Guide to Children's Dental Care in Medicaid, Policy Issues in the Delivery of Dental Services, 2010 Eight-State Medicaid Dental Review Summary Report, AAPD State EPSDT Dental Periodicity Schedules, Find a Medicaid/CHIP Dental Provider in your State, Oral Health Care During Pregnancy: A National Consensus Statement, Tips for Good Oral Health During Pregnancy, Keep Kids Smiling Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents, 2010 Medicaid/CHIP Oral Health Services fact sheet, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents, Related Technical Assistance Brief Dental Sealant Measure, Early and Periodic Screening, Diagnostic and Treatment, Medicaid Oral Health Performance Improvement Projects: A How-To-Manual for States, Medicaid Oral Health Performance Improvement Projects: A How-To-Manual for Health Plans, Medicaid Oral Health Performance Improvement Projects: A Template, Reducing Early Childhood Tooth Decay: An Overview for State Policymakers, Reducing Early Childhood Tooth Decay: Leading Steps for State Policymakers, Reducing Early Childhood Tooth Decay: Strategies for State Medicaid and CHIP Program Managers, Innovative State Practices for the Provision of Dental Services in Medicaid, Learn how to improve the quality of the dental data reported on the Form CMS-416, the annual report of services provided to children receiving the Medicaid. 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 the state's Medicaid plan. An official website of the United States government. The topic of Medicare and Medicaid dental coverage causes a lot of confusion for people looking for a way to help pay for dental work. Contact Information. You can buy a dental-only plan or a health plan that includes dental on Maryland Health Connection during open enrollment Nov. 1 to Dec. 15. See the 2010 Medicaid/CHIP Oral Health Services fact sheet (PDF, 49.06 KB)  for information on children's access to dental services and opportunities and challenges to obtaining care. Select your state to find information on health insurance programs in your state or call 1-877-KIDS-NOW (1-877-543-7669). See below for more detail. Local, state, and federal government websites often end in .gov. Enroll in a dental-only plan or add dental when you buy a health plan. While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. The state of Washington calls their Medicaid services program "Washington Apple Health." Implementation was originally scheduled for April 2020, but was delayed by the coronavirus pandemic. Dental services for children. Web Portal: To sign up for updates or to access your subscriber preferences, please enter your contact information below. Each state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health care. The Rhode Island Medicaid Program provides dental services for people with Medicaid coverage. There are no minimum requirements for adult dental coverage. Find Coverage for Your Family. Please print, copy, link to and share. Does Washington Medicaid Cover Dental? Members may choose to download a copy of the Member Handbook, or contact Member Services to request a hard copy to be sent by mail.Maryland Healthy Smiles Member Services: 1. From 2007 to 2011, almost half of all states (24) achieved at least a ten percentage point increase in the proportion of children enrolled in Medicaid and CHIP that received a preventive dental service during the reporting year. Adult dental coverage is optional for state Medicaid programs, but most offer at least an emergency dental benefit. The Centers for Medicare & Medicaid Services (CMS) is committed to improving access to dental and oral health services for children enrolled in Medicaid and CHIP. Toll Free Call Center: 1-877-696-6775​, U.S. Department of Health & Human Services. It provides an overview of the children's dental benefit in Medicaid, support for evidence-based policies at the state level, and details of successful strategies with state examples. Some states offer only limited dental coverage, and some do not offer dental coverage at all. We have been making considerable progress (PDF, 303.79 KB) in our efforts to ensure that low-income children have access to oral health care. Before sharing sensitive or personal information, make sure you’re on an official state website. The program's focus is on prevention, early diagnosis,  and treatment of medical conditions. These fact sheets give information about dental coverage. SOHAPs may be submitted using either a CMS-developed Oral Health Action Plan Template or a user-friendly template developed by the Medicaid-CHIP State Dental Association. Dental; Dental Plans and Program; Dental Plans and Program . Dental services are available out-of-plan, meaning, not paid for by the health plan a person is enrolled in. A referral to a dentist is required for every child in accordance with each State's periodicity schedule and at other intervals as medically necessary. Dental services for children must minimally include: The EPSDT benefit requires that all services must be provided if determined medically necessary. NEW CASTLE (Sept. 29, 2020) – Adult Delawareans who receive Medicaid will automatically get dental coverage as part of their plan starting Oct. 1. EPSDT is a mandatory service required to be provided under a state's Medicaid program. Anthem Member Services: 866-805-4589 Colorado Child Health Plan Plus Member Services: 888-307-6561 DentaQuest Member Services: 844-254-9490 TTY Number: 800-466-7566 Health First Colorado Member Services: 855-225-1729 Health First Colorado Provider Relations/Services: 855-225-1731 PAR line: 855-225-1947; TTY: AT&T Relay Service 711 Any questions about the SOHAPs may also be directed to Mr. Snyder. Dental services must be provided at intervals that meet reasonable standards of dental practice, as determined by the state after consultation with recognized dental organizations involved in child health, and at such other intervals, as indicated by medical necessity, to determine the existence of a suspected illness or condition. This fact sheet identifies key challenges related to oral health care access and utilization for low-income adults, and outlines states’ current coverage of dental benefits for adults in Medicaid. It also highlights States with a separate CHIP program may choose from two options for providing dental coverage: a package of dental benefits that meets the CHIP requirements, or a benchmark dental benefit package. Apple Health (Medicaid) pays for covered dental services for eligible children, age 20 and younger. Dental services may not be limited to emergency services for EPSDT recipients. To find a dental plan, use a computer and go to or call 1-877-711-3662 to talk to a Florida Medicaid Choice Counselor. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. recent survey of Medicaid dental program managers by the National Academy for State Health Policy (NASHP) and the Medicaid-SCHIP Dental Association is the source of this update on the status of states’ Medicaid coverage of adult dental services. See the Children's Dental Benefits page for more information about benefits for Health First Colorado members under age 21. This document is a companion to the fact sheet, Medicaid Adult Dental Benefits: An Overview, which outlines states’ coverage of dental benefits for adults in Medicaid. States are also required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages on Dental services may not be limited to emergency services for children entitled to EPSDT. The Academy of Pediatric Dentistry (AAPD) recommends all children see a dentist by 12 months of age. There are a plethora of questions surrounding healthcare and especially dental care in the US. To find out more information regarding participating dental providers, covered services for children and adults, and information on school-based dental services visit the Illinois Department of Healthcare and Family Services webpage.