Medicaid has always been a popular healthcare option for low income people. Since the Affordable Care Act was signed into law in 2010, Medicaid expansion became one of its main features. Yet, while it covers a wide gamut of services, including dental services for children, it tends to be deficient in the area of dental benefits for adults. Limited access to oral healthcare can affect one’s overall health. Poor oral hygiene can lead to seemingly unrelated conditions like heart attack and stroke. The degree to which Medicaid offers adult dental services varies state to state.

Children’s Dental Services

Children younger than 21 who are covered by the Children’s Health Insurance Program (CHIP) are automatically eligible for dental benefits under Medicaid. This is all part of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, which requires that dental services be provided if deemed medically necessary.

Adult Dental Services

States have the option of deciding which dental benefits, if any, adults would receive. Though emergency dental care is guaranteed in most states, fewer than half provide extensive care. Studies show that 27 percent of adults 20-64 have untreated cavities. Forty-four percent of adults with an income below 100 percent of the federal poverty level (FPL) have cavities that have gone untreated. Seventeen percent of adults who have an income level at or above 200 percent of the FPL have untreated cavities. Figures are much higher for blacks and Latinos compare to whites.

Why Are There So Many Restrictions for Adults?

Medicaid severely restricts many adults’ access to dental care largely because of the cost involved. In fact, many states set a cap on the amount they’ll spend per person, or they impose a limit on the number of services they’ll offer. In February, 2016, fifteen states offered adults on Medicaid a broad array of dental services, which included a blend of preventive, diagnostic and restorative services, with an annual cap of at least one thousand dollars. Nineteen states, however, gave adults on Medicaid limited dental benefits with a expenditure ceiling of less than $1,000. Thirteen states provided dental services only for emergency care, covering things like injuries and extractions as well as pain relief. Yet, four states didn’t offer adult Medicaid recipients any dental services. A tragic aspect of all this is that some recipients, though they may have access, still face high out-of-pocket costs, frequently making it cost-prohibitive.

Often a state’s economic picture affects the state of Medicaid dental services for adults. For instance, California dumped non-emergency dental benefits for adult Medicaid recipients, but restored many of the services in 2014. Illinois also eliminated access to non-emergency dental services in 2012, but two years later reinstated its benefits, including such services as oral surgery, dentures and limited fillings.

For more information on dental services offered to Medicaid beneficiaries, please contact us.