Children’s Dental Care Under Medicaid

Medicaid provides Dental care for individuals aged 21 years and below which includes children. In fact, it is mandatory for Medicaid to provide a comprehensive child health program as it is required by the law. This program is known as Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Children’s dental care under Medicaid is part of this program.

As the customary practice, children or even adults, consult with a dentist at least twice a year as part of regular check-up. This same practice also applies if your child is under Medicaid dental care service. The dental services include restoration of teeth and maintenance of dental health. Medicaid has a list of accredited dentists and dental associations that offer children’s dental care.

A child is required to have a direct dental referral in order for the dentist to perform dental examination. The direct dental referral is provided by the state. EPSDT requires that Medicaid extend all coverage of the program to EPSDT recipients, as deemed necessary by the state. If in the course of oral examination, a procedure must be done, the state will have to provide necessary service or services to treat the condition, even if the treatment required is not included in the state’s Medicaid plan.

Early dental screening is a part Children’s dental care under Medicaid. EPSDT actually requires early screening and education to prevent children from developing “baby bottle tooth decay” and other tooth related problems that may arise in early childhood. If this kind of condition will remain untreated, it can cause tooth decay and infection that may lead to hospitalization and may require severe treatment.

In spite of all the efforts being done by the state to convince parents and families to utilize dental care services provided by Medicaid, there are still many who do not seek dental health care. This is mainly because a lot of dentists do not accept Medicaid patients. The reason why there is a shortage of dentists who are willing to accept Medicaid patients is primarily because of inadequate reimbursements. As we all know Medicaid is a public health insurance that caters to low-income families. Medicaid does not actually require premium payment from those who are under their coverage. Additionally, Medicaid also pays the provider directly for the services already rendered.

Dentists also complain about Medicaid’s slow settlement of payment. And when they do not receive ample payment they will refuse patients under Medicaid. Until such time that issues between Medicaid and the dental care providers are resolved, we will see less children taking advantage of the dental care benefit under Medicaid.

There is another type of dental coverage that is being run for Centers for Medicare and Medicaid Services. This is known as State Children’s Health Insurance Program (SCHIP).

SCHIP eligibility is based on age, family size and annual income. SCHIP allocates coverage through statewide network of professional service providers including dentists. Patients under SCHIP use network providers except for emergency cases.

Those under SCHIP should consult with their local health department to get a list of dentists who accept patients under the program.


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