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Medicaid Dentists and Dental Coverage
Dental care is important because taking care of your teeth and gums is an essential part of maintaining your overall health and preventing health problems in the future. Proper dental care is especially important for your children.
In spite of improvements in childrens oral health care, the most common chronic disease of children is tooth decay. In fact, severe pain and infections can result from tooth decay, and in extreme cases can also result in death.
Children from low-income families tend to be at a higher risk of tooth decay and dental problems because they are less likely to get treatment from a dentist on a regular basis. A recent national survey found that almost 80 percent of children two to five years of age from low-income families had tooth decay that was not treated. The same study found that 40-50 percent of low-income children ages 6-14 had untreated tooth decay.
As you know, a trip to the dentist can be expensive. There are several ways that you can deal with dental expenses. You can pay the total amount of the dentist bill yourself, you can purchase affordable dental plan insurance, or you may qualify for dental coverage through Medicaid.
Dental services under Title XIX of the Social Security Act, the Medicaid program, are an optional service for the adult population, individuals age 21 and older.
However, dental services are a required service for most Medicaid-eligible individuals under the age of 21, as a required component of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.
Dental Coverage Individuals under Age 21
EPSDT is Medicaid's comprehensive child health program. The programs' focus is on prevention, early diagnosis and treatment of medical conditions. EPSDT is a mandatory service required to be provided under a state's Medicaid program.
Medicaid dental services must be provided at regular intervals that meet reasonable standards of dental practice, as determined by the state in which you live. These dental schedules are set after consultation with recognized dental organizations involved in child health, and at such other intervals, as indicated by medical necessity, to determine the existence of a suspected illness or condition.
Dental services under Medicaid must include at a minimum, relief of pain and infections, restoration of teeth and maintenance of dental health. Dental services may not be limited to emergency services for EPSDT recipients.
Oral screening may be part of a physical exam, but does not substitute for a dental examination performed by a dentist as a result of a direct referral to a dentist.
A direct dental referral is required for every child in accordance with the dental schedule set by the state.These usually begin between the ages of one and three years. The dental referral must be with a licensed dentist for diagnosis and necessary treatment.
Not all dentists accept Medicaid. For dental treatment you will need to locate a "Medicaid dentist" who is enrolled in the Medicaid program and is willing to provide dental care to people that are covered by Medicaid. In some states, only a third of the dentists accept medicaid payments. Be sure you ask if the dentist accepts Medicaid before you make an appointment.
As you can imagine, there are also different types of dentists that provide different types of dental treatment. These dentists include general dentists that provide exams, x-rays, and overall dental care. There are dentists that only provide dental services for children and they are called pediatric dentists. Some states also have dental services available at local Community Health Centers and Health Departments.
In addition to general dental care, there are also specialized dental services which include endodontists that perform root canals, oral surgeons that extract teeth, orthodontists that provide braces, and periodontists that prevent and treat gum disease.
The reason for visiting a dentist at an early age is because of several reasons:
1. The high level of dental disease found in infants and preschool age children that are eligible for Medicaid.
2. Greater potential to detect and treat tooth decay before there is much damage to the teeth or spread of infection.
3. It is more difficult to detect problems with tooth decay without the aid of x-rays after the teeth erupt and are in contact which usually happens around the age of two.
4. Professional dentist guidelines recommend initiating dental care by the age of 1, with periodic 6 month visits to the dentist for regular care.
The Centers for Medicare & Medicaid Services does decide what specific dental services must be provided, however, EPSDT requires that all services coverable under the Medicaid program must be provided to EPSDT recipients if determined to be medically necessary. Under the Medicaid program, the state determines medical necessity.
If a condition requiring treatment is discovered during a dental screening, the state must provide the necessary dental services to treat that condition, whether or not such services are included in the state's Medicaid plan.
Dental Treatment Services
Medicaid requires that dental care must be provided at the earliest age possible, needed for pain relief and to treat infections, restoration of teeth, and maintenance of dental health.
Some of the specified dental treatments may include:
* Scaling of the teeth to control gingivitis and periodontal diseases.
* Orthodontic treatment when medically necessary.
* Pulp treatment and root canals for permanent and primary teeth.
* Providing dentures if chewing is impaired.
Emergency dental services and care are also provided in the following situations:
* Dental procedures that are necessary to control bleeding, treat infection, and reduce pain.
* Treatment of injuries to the teeth, gums, or bone. This may include stabilizing loose teeth, cleaning and stitching open wounds.
* Dental procedures that prevent "pupal death" caused by infection of the nerves and blood vessels inside the tooth and the loss of teeth.
Dental Coverage Individual age 21 and older
States may elect to provide dental services to their adult Medicaid-eligible population or elect not to provide dental services at all as part of its Medicaid program.
While most states provide at least emergency dental services for adults, less than half of the states provide comprehensive dental care. There are no minimum requirements for adult dental coverage.
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