How much does medicaid cover for braces

The Medicaid program is jointly funded by the State and Federal governments and provides health benefits to American citizens. However, many people are unaware of its immense low-cost programs and rules for various states. It was created to help low-income adults, children, pregnant women, elderly adults and people with disabilities by providing medical assistance. So far it has done a great job of helping millions of Americans across the country receive health benefits.

Medicaid, a Federal Government States program that has been running since 1965 has various health programs. The eligibility requirements and health benefits of the program differ based on what state you live in. The program is also very extensive, with many complex rules and regulations.

If you're enrolled in Medicaid as an adult, it's important to know what dental services are covered. The program is constantly changing, so read on to find out which services will be available for adults in 2022. 

Eligible Adults for Medicaid Dental Services 

Medicaid covers various health services, and to check your eligibility; you have to contact the State Medicaid Agency. Some states provide full-fledged services, while some have different eligibility criteria.Initially, Medicaid dental was available only for children, but the ever-evolving program has extended its programs. In the past years, there have been huge increases in dental problems in adults, especially the people who can't afford the cost of dental hygiene.

All these statistics lead to the expansion of the Medicaid program. It is now available for all adults above 21; those with insufficient incomes, disabilities, older people, and pregnant women can access the services. 

The emergency services are available in all states, while more comprehensive ones are limited to some States (also check out Medicaid services). 

Medicaid Dental Cover for Adults

Each state has different plans, costs, and services for its residents. So determining whether Medicaid covers a specific treatment is a thorough process. First, you have to search clinics providing Medicaid dental services and assess what services you can benefit from the program.

For example, some states allow surgery in case of accidents that have resulted in teeth loss and injury. The concerned clinics can provide effective tooth replacement and treat other injuries.

Some of the common procedures of Medicaid coverage for adults are:

• Each state has specific regulations about which dental specialty areas they possess.
• Medicaid is health insurance across the nation, which means all eligible citizens might enjoy advantages for medically required assistance.
• The least costly alternative rule concerns what your plan might pay for implants, dentures online, orthodontia, and other services.
• The Medicaid dental program charged with processing claims for your family is the final authority.

Dental Benefits for Children by Medicaid

Dental benefits are not included in emergency services, and every state has to follow a periodic diagnosis of dental care for children. The enrolled children can go for oral screening and routine schedules.

After having a regular checkup, the dentist can refer some cases for treatment. It can be dealing with infections and pains, performing successful broken tooth repair, and maintaining dental health.

The dental services for children in all states must include:

• Relief of pain and infections
• Restoration of teeth
• Maintenance of dental health

These dental benefits are regulated under Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Every state has to schedule appropriate dental checkups for children and refer the concerned cases forward.

Dental Services Children in CHIP

The children enrolled in Children's Health Insurance Program (CHIP) can also use Medicaid Dental services. The Medicaid expansion program provides dental services to children from low-income families who do not qualify for private insurance.

It covers dental services for children like;

• Procedures necessary to prevent disease and promote oral health
• Restore oral structures to health and function
• Treat emergency conditions. For example, assisting weak teeth with a durable dental crown.

What Dental Services Does Medicaid Cover for Adults?

The dental Medicaid plan can cover many treatments according to your State's rules. The clinics will accept the Medicaid insurance considering these two points:

• The health insurance segment of Medicaid pays for medically necessary oral care uniformly across the nation, and a Managed Care Organization (MCO) administers claims.
• The dental insurance part of Medicaid pays for oral care that is not medically necessary unevenly in each State, and a Dental Benefits Manager (DBM) makes claims decisions.

Medicaid Insurance Covers

Restorative Care

The restorative care procedure is done to repair or replace decayed, damaged, or missing teeth. Also, it may include successful dental implantation after an accident or any emergency to stop further loss of dental health. In addition, it provides dentures, root canals, and crowns to repair the teeth. Some of the remedies under restorative care are:

• Providing affordable and effective dentures
• Performing root canal treatment
• Installing crown over the tooth.

Although these are very low-cost treatments funded by respective States and the Federal Government, they have some limitations. As a result, the states check how many times you can opt for the same service.

Oral Surgery 

Oral surgeries by a concerned dentist to treat injuries, potential diseases, and emergencies come under the Medicaid cover. It may include wisdom tooth removal and corrective jaw operations. 

Dental Emergencies

Dental emergencies arising from prolonged disease and accidents are compulsory for all the States to handle. The Medicaid clinic will proceed with low-cost emergency services for the people using Medicaid insurance. This includes:

• Extractions of broken teeth after an accident
• Root canals after non-biting trauma

But, Sixteen states provide limited emergency oral care services only, and that is:

• Processes required to handle bleeding, reduce distress or stop critical diseases
• Assistance is needed to prevent "pulpal death" and the coming loss of teeth.

Orthodontic Braces

The Medicaid program won't pay for orthodontic dental services, and few exceptions exist. It will pay for braces under the health insurance scheme. In addition, orthodontic dental services for an emergency can be covered.

For example, repositioning teeth after a non-biting accident or treating sleep apnea or Temporomandibular Joint Disorders (TMJ or TMD). By knowing which treatments are covered under Medicaid services and insurance, you can get low-cost treatment options.

Preventive Dentistry

Medicaid can sometimes include preventive dental care. It includes regular oral exams, cleanings, fluoride application, sealants, and X-rays that help patients avoid decay, gum inflammation, and tooth loss.

It's an oral care program that encourages healthy dental habits and preventative measures. Thirty-one states offer preventive dental services as part of the program.

Periodontal Treatment

Only a few states provide periodontal treatment services for Medicaid-enrolled people. It deals with precautionary steps to avoid, diagnose and treat gum diseases. Gingivitis is one of the common diseases which fall under it. Only nineteen states give this benefit under the Medicaid program.

You can look for these Periodontal Treatment services in eligible states:

• Deep cleaning (root planing and scaling)
• Gingival flap surgery to treat late-stage disease
• Gum grafting to address receding gum lines

Medicaid excludes all dental beautification services. For that, you have to opt for authentic cosmetic enhancement services which are readily available. So, these were all the services, terms, and conditions for Medicaid insurance.

The various States Covering Medicaid for Adults

Here's the list of all the services provided by every State of the US:

Extensive Medicaid dental coverage

Alaska, California, Connecticut, Iowa, Massachusetts, Montana, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Rhode Island, Washington, and Wisconsin.

Limited Medicaid dental coverage

Arkansas, Colorado, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Montana, Nebraska, Pennsylvania, South Carolina, South Dakota, Vermont, Virginia, and Wyoming.

Emergency Medicaid dental services

Arizona, Florida, Georgia, Hawaii, Idaho, Maine, Maryland, Mississippi, Nevada, New Hampshire, Oklahoma, Texas, Utah, and West Virginia

No Medicaid dental coverage

Alabama, Delaware, and Tennessee

Expanded Medicaid under the Affordable Care Act

Arizona, Hawaii, Maryland, Nevada, New Hampshire, West Virginia, Arkansas, Colorado, Illinois, Indiana, Kentucky, Louisiana, Michigan, Minnesota, Pennsylvania, Vermont, Alaska, California, Connecticut, Iowa, Massachusetts, Montana, New Jersey, New Mexico, New York, Ohio, Oregon, Rhode Island, and Washington

Wrapping up

So, these were all the updated terms of Medicaid dental cover for adults in 2022. In order to learn if you are eligible and what benefits your state provides, contact your state insurance office. Once you have done that, find the clinics who help Medicaid individuals in order to discover your benefits. At Instasmile we offer clip-on veneers allowing you to achieve your perfect smile without having to visit the dentist. 

Takeaway

You can get access to various dental procedures through the Medicaid program. You have to check the eligibility criteria for each state and enroll in the program. Learn what benefits you can take from the dental services of each state. This information will help you have low-cost procedures and healthy dental health. For those with a limited Medicaid programme we offer clip-on veneers allowing you to achieve you're perfect smile again without having to visit a dentist reducing the cost.