Medicaid dental coverage for adults and children is different. States have much more leeway in determining the level of dental care for adults: fewer than half provide comprehensive dental care, but most offer emergency services, explains Medicaid.gov. However, states are required to comprehensively cover children’s dental health care under Medicaid.
Medicaid comprehensively outlines coverage for children as part of the Early and Periodic Screening, Diagnostic and Treatment benefit, but it leaves some details of the implementation to the states, says Medicaid.gov. Medicaid requires dental examinations according to a state’s periodicity schedule and mandates that services available to children at least include maintaining their current dental health, restoring teeth, and relieving pain and infections. In addition, regardless of whether a state covers a given treatment or not, if that treatment is necessary for a condition found in a screening, the state must cover that treatment.
If any services are medically necessary, states are required to provide them, states Medicaid.gov. Each state determines whether treatment for a condition is medically necessary or not, and it sets its own periodicity schedule for dentist referrals. Dental health organizations focusing on child medical care assist states in developing periodicity schedules. All provided services must be available at periods that are in accordance with accepted standards of dental care or periods dictated by medical necessity.