Dental Implants & Medicaid

The Medicaid program provides health care assistance to persons with low income and limited resources. Although the federal government sets basic guidelines for Medicaid that each state must follow, the states have significant latitude to set eligibility guidelines and determine what health care benefits will be provided. States have the option to decide whether to provide dental coverage for Medicaid recipients over 21 and, if provided, whether to cover services for dental implants 1.

Medicaid Eligibility

Medicaid pays for medical services for low-income persons, often completely covering the cost of the services. The program is jointly funded by the federal and state governments, but is managed by the states. Federal government poverty guidelines are used as the baseline for each state to set the low-income eligibility requirement. For example, in California, the state’s Medi-Cal program administers Medicaid benefits and any person who receives certain government benefits, such as such as Supplemental Security Income or Refugee Assistance, is Medicaid-eligible.

Medicaid Dental Coverage - under 21

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Any person under 21 who is Medicaid-eligible is required to receive the Early and Periodic Screening, Diagnostic and Treatment, or EPSDT, benefit. The primary purpose of the EPSDT benefit is the prevention, early diagnosis and treatment of medical conditions and includes dental services. If implants are needed to replace primary or permanent teeth, Medicaid covers the cost of this service.

Medicaid Dental Coverage - over 21

Federal guidelines permit each state to decide whether it will provide dental services for persons over 21 who are Medicaid-eligible 1. According to the federal Centers for Medicare & Medicaid Services, or CMS, most states provide emergency dental services for adults; however, more than half of the states do not provide non-emergency dental care 1. Because there are no minimum requirements for adult Medicaid dental coverage, it is up to each state to decide whether it will provide coverage for implants 1.

State Medicaid Dental Programs for Adults

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Information regarding the dental benefits provided to adults by a state's Medicaid program can be obtained from the state's Medicaid office where applications for Medicaid are taken 1. The American Dental Association also maintains a web site with a searchable database by state regarding the Medicaid dental benefits provided 1.

SCHIP Dental Coverage

The federal Centers for Medicare and Medicaid Services also operates the State Children's Health Insurance Program, SCHIP, that provides health care services for children whose family do not qualify for Medicaid. Each state has a network of health care providers, including dentists that provide coverage for SCHIP-eligible children.