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The hunt for a dental provider can be daunting. With Medicaid, there is an abundant number of factors to consider before choosing the right dentist. States must provide dental benefits for children covered by Medicaid and have the flexibility to determine what dental benefits are provided to adults enrolled in Medicaid. Dentists will differ in coverage and benefits, so it is crucial to make the choice that is right for you. Before looking for a dentist, you should know the benefits you or your beneficiaries are entitled to.

Benefits for Individuals Under 21

Medicaid covers dental services for all child enrollees under a set of benefits referred to as the ‘Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.’ Dental services for children must minimally include relief of pain and infections, restoration of teeth, and maintenance of dental health.

With Medicaid, all children are entitled to oral health screenings, diagnosis, and treatment. With EPSDT benefits, individuals must have their dental care provided to them in a regular schedule to ensure there are no illnesses or conditions with the individual. Medicaid also require that all services be provided if deemed medically necessary. However, medical necessity is deemed by the state.

Benefits for Individuals Over 21

For adults over the age of 21 enrolled with Medicaid, states have the flexibility to determine dental benefits. Most states will at the very least provide emergency dental care, but less than half of the states will provide comprehensive dental care.

Unlike child benefits, there are no minimum requirements for adult dental coverage. Dental coverage for adults with Medicaid can be tricky and there are fact tables you can look at to determine if your state covers your dental benefits.

Medicaid Dental Coverage for Adults

Finding a Match

To find a dentist with Medicaid, you can look at Medicaid sites for each state that will direct you with a phone number to a Health Program Representative that can help you find a dentist that fits the plan you are under.

Databases are especially helpful in helping you find the right dentist. Just pick the state you live in, enter the Medicaid plan you are enrolled in, and enter information on your geographic area as well as any other optional search criteria you may want to add. If you are unsure of the type of Medicaid plan you have, you can inquire about it by calling your insurance provider. From there, you will get a list of dentists in your area that can provide you with the care you need.

Narrowing it Down

Once you have a list of the dentists, you are going to want to compile a list and narrow down your options. Many dentists offer the same benefits and have similar backgrounds and experiences, so it may be overwhelming to pick the right one.

Further research can help you find your next dental provider. This may include researching the coverage they provide, the dentist’s expertise, and their proximity to you. You will want to read up on reviews that other patients have left and begin to narrow down your options.

Set up a consultation over the phone with potential matches if you are unsure of which dentist to choose. When you have completed your research, all you have to do is book an appointment! Finding a dentist with Medicaid has never been so easy!

Story Written By: Jiayu Tang