Which Dental Services Does Medicaid Cover for Children?

Every child deserves great dental care. When children don’t get the dental care they need, it can create bigger overall health issues. That’s one of the reasons the Centers for Medicare and Medicaid Services (CMS) requires that every state give any child enrolled in Medicaid dental benefits. This same benefit isn’t always extended to adults.   

Dental Services Covered by Medicaid 

Children under 21 years of age enrolled in Medicaid receive a comprehensive set of benefits known as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This was introduced in 1967 to give the “right care to the right child at the right time in the right setting.” At minimum, children must receive dental services that:  

  • Maintain dental health 

  • Restore teeth 

  • Relieve pain and infections 

In addition, if a dental condition is uncovered through a regular dental examination and it requires treatment, the state must also provide the necessary treatment even if it isn’t normally part of what that state covers.  

Here are examples of common dental services that might be provided include: 

  • Regular dental cleanings and exams 

  • Fluoride treatments 

  • Dental sealants 

  • Fillings 

  • Crowns 

  • Extractions 

  • Other dental services that are medically necessary (this includes emergency treatment as well) 

If your child is covered by Medicaid, you will not need to pay co-payments or premiums for your child’s dental care. Our office is familiar with and will interact with the Medicaid office if there are any questions about our treatment plan. Find Medicaid and the Children’s Health Insurance Program (CHIP) coverage options for your family. 

Orthodontic Care Covered by Medicaid 

Since orthodontic treatment isn’t only about beautifying a smile or done for cosmetic reasons, orthodontic treatment that is deemed medically necessary could be covered by a Medicaid dentist. Oftentimes, crooked teeth or a misaligned bite can cause gum disease, tooth decay or other oral and general health issues. Therefore, in some cases, Medicaid will cover orthodontic treatment for children with malocclusion (bite issues) including underbite, overbite, crossbite or severe crowding.  

Our office and the American Association of Orthodontists recommend children get their first orthodontic evaluation by the age of 7 years old. At this age, we can be proactive about orthodontic treatment and even begin some preventative measures if they are available in your child’s situation.  

Why Medicaid Dental Coverage for Children is So Important 

Tooth decay is one of the most common—but also preventable—chronic childhood diseases. Dental issues can negatively impact many areas of a child’s life including sleep habits, school performance and self-esteem. Children covered by Medicaid get recommended dental care more than those who are uninsured. While a physician may examine your child’s mouth during a routine physical, this is not a replacement for a dental exam completed by a Medicaid dentist.  

Early childhood tooth decay can create issues for children as they continue to grow. Since decay can be minimized or prevented with proper oral hygiene and diet, it’s important to have children begin seeing their dentist by age 1. This helps parents learn how best to help their children take care of their teeth and get the dental services they need to avoid tooth decay.  

Although the first teeth your child get are ultimately lost to make room for their permanent teeth, proper care and keeping “baby teeth” healthy is essential to ensure the future health of permanent teeth. Baby teeth hold the spot for permanent teeth to break through the gums at around age 6.  

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