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Things Medicaid Dental Members Should Know Before Visiting the Dentist 

By Mike Kilduff, Jeanine Saer, & Tina Johann

SKYGENUSA Powering Healthcare for the Digital Age


Dental wellness is an important contributor to your overall health and wellbeing. It can have an effect on your ability to eat the foods you want, speak clearly, and even sleep at night. It can also have an effect on your self-esteem, the way you interact with others socially, and your ability to enjoy life to the fullest.

The impact is even greater on infants and children. Tooth decay is one of the most common chronic diseases of childhood and can occur as soon as a child’s first tooth breaks through the skin. Tooth decay can affect a child’s physical growth (through poor eating habits), speaking, playing and learning. It can also cause significant pain, loss of school days, and may lead to infections or even death. Making sure your child sees the dentist early and regularly can do wonders for his or her health and happiness.

Dental wellness has also been shown to have a direct effect on the mother and baby during pregnancy as well as people with certain chronic diseases such as diabetes and heart disease.

That’s why we’ve put together this blog post – to provide some guidance on what you as a Medicaid dental member can be doing, when you should be doing it, and how to avoid problems. Let’s start with…

Good things to know

We understand you may have some questions about your Medicaid dental coverage. Here are some things you should be aware of:

  • You should take your children to the dentist in their first year. The American Academy of Pediatric Dentists recommends taking children for their first visit when the first tooth appears, or no later than his/her first birthday.
  • Children have different coverage than adults. Under the Essential Health Benefits provision of the Affordable Care Act (ACA), states are required to offer certain Medicaid dental benefits for children. While each state sets their own benefits, they are minimally required to offer relief of pain and infections, restoration of teeth, and maintenance of dental health. There are no minimum requirements for adults, although most states do provide coverage of emergency dental services.
  • Medicaid dental covers a very specific set of services. Medicaid generally covers a very specific set of services, and others only as a “medical necessity.” Check your written policy, or if your dental provider has an online web portal where he or she shares information with you, look there.
  • You should start with a general dentist first. You should start with a general dentist first as that will give you the broadest coverage in case the problem isn’t what you think it is. If a specialist is needed, the general dentist can direct you to the right one.
  • You have a choice of dentists, even if you’ve been assigned a “dental home.” You can still choose to visit another dentist as long as he or she accepts your insurance and is participating in the plan. In some instances, you may find a list of participating dentists on your plan’s website.
  • Medicaid dental members do not have to wait longer to see the dentist than commercial insurance patients. By law, there should be no difference in the wait times.

Here are a few things you can do to make sure you’re getting the most from your Medicaid dental coverage:

  • Review your benefits thoroughly on the state’s website so you understand what is covered – and what is not. Also make sure you’re still actively enrolled in the program.
  • Call your dentist to confirm he/she accepts your Medicaid insurance plan and is participating in the network.
  • Contact your state enrollment agency with any updates to your personal information.
  • If your dentist has a website where you can register to obtain your personal information, sign up for it. You can then receive reminders or results of visits, get updates on new types of care or benefits, check on financial progress toward any maximum benefits, and look up your (or your family’s) treatment history.
  • If your dentist’s office hasn’t confirmed your appointment already, call or email a day ahead to make sure everything is all set. Better to be safe than sorry, especially if you have to take off work to go.
  • Plan ahead for transportation and child care (if needed) rather than potentially missing an appointment. Check with local social services agencies to see if they can make transportation or child care available.
  • Provide your dentist with information about your primary care physician (or child’s pediatrician).Also submit a list of any medications, history of gum disease in the family, mental/physical disabilities, or concerns such as a child’s high anxiety in certain situations that might present additional challenges.
  • Make a list of any questions you may have or pain you experience now and take that list with you to your visit.

By following the steps above, you can ensure you get the most from your visit while saving yourself some time-consuming problems and potential inconvenience.

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