Medicaid dental coverage for children and adults

Good oral health is important for everyone no matter what their age. The health of your mouth, teeth and gums is linked to your overall health. Problems in your mouth can affect the rest of your body.

Tooth decay and gum disease can lead to bad breath, mouth infections and loss of teeth. There may also be a link between oral infections and diabetes, heart disease and stroke. Besides brushing and flossing each day, it's important to visit the dentist for regular checkups and cleanings. The dentist will check the health of your mouth. Catching problems early may make them easier to fix.

Each state manages its own Medicaid program. So each state can choose what dental benefits it provides to adult Medicaid enrollees. Most states cover emergency dental services for adults. But less than half of U.S. states currently provide comprehensive dental care. There are no minimum requirements Medicaid dental coverage for adults. Search Medicaid plans where you live to see if adult dental coverage is offered in your state.

Medicaid covers dental services for children under age 21 who are enrolled in Medicaid. Dental care is part of a complete set of benefits that children and adolescents need for proper preventive and developmental care.

State Medicaid agencies can design their dental programs. But they must cover more than just emergency services. All Medicaid children’s dental programs need to include these 3 things:

1. Relief of pain and infections
2. Restoration of teeth
3. Maintenance of dental health

If a child needs dental care that’s medically necessary, Medicaid will cover those services. Also, if a health condition that needs treatment is found during a routine health screening, Medicaid will cover that treatment. It doesn’t matter whether the care services are included in a state's Medicaid plan or not.

CHIP is the Children's Health Insurance Program. CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP dental benefits are the same as the state’s Medicaid program. In other states, CHIP is a separate program from Medicaid. If so, a state can choose to offer children’s dental benefits that are equal to 1 of these 3 options:

1. The most popular federal employee dental plan for dependents
2. The most popular plan selected for dependents in the state's employee dental plan
   or
3. Dental coverage offered through the most popular private insurance plan in the state

There's no standard list of services for children's Medicaid dental coverage. States choose what care and treatments are covered by Medicaid and how often. Some states may cover dental checkups and cleanings 2 times a year. Other states may only cover 1 routine dental visit.

Tooth decay, or cavities, is the most common disease of children aged 6–18.¹ So, it’s not surprising that Medicaid programs put a lot of emphasis on preventing cavities. Some common treatments may include*:

• Dental exam and x-rays — The exam allows the dentist to check the teeth and gums for any cavities or other issues. X-rays are pictures that let the dentist see the tooth roots, check the bones around the teeth and look for signs of cavities or other diseases.
• Dental sealants — These thin plastic coatings are painted on the molars (back teeth). Sealants fill in pits and grooves that can trap food and germs, and lead to cavities.
• Fluoride treatments — The dentist uses a brush or cotton swab to paint a temporary coating on teeth. Fluoride helps stop new cavities from starting and stop existing cavities from spreading.

Medicaid will typically cover other dental services when they're medically necessary. Such braces to straighten children's teeth. Or removing wisdom teeth. But guidelines for medical necessity may vary from state to state.

Millions of children and teens qualify for free or low-cost health and dental coverage through Medicaid and CHIP. And that number goes up each year. But access to care is a big challenge. Some children may not have a dentist in their neighborhood. Or they may lack transportation.

Some families don't understand that children need to see a dentist regularly, even when there are no obvious problems. Some parents don't know that their children are eligible to get dental services. Language barriers can also make it more difficult to get dental care.

UnitedHealthcare is committed to helping our members take advantage of all the benefits offered through their Medicaid health plan. Visit InsureKidsNow.gov to find a dentist in your community who sees children and accepts Medicaid and CHIP.

*Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. For details about the exact benefits available in Medicaid plans in your area, please search plans using the ZIP code where you live.
¹ Children’s Oral Health (CDC, April 6, 2022)