Medicaid is a program funded jointly by states and the federal government that provides health coverage to over 84 million eligible Americans, or approximately one out of every five people. It’s often referred to as the nation’s public health program because it provides health services to people who might have trouble affording them, such as:
- Low-income adults.
- Children.
- Pregnant women.
- Elderly adults.
- People with disabilities.
If you’re on Medicaid, you know that it provides invaluable coverage for services such as inpatient and outpatient hospital services, doctor bills, laboratory and X-ray services, and home health aid, but does Medicaid cover dental care, another critical component of your health and well-being? Penn Dental Medicine at PHMC on Cedar explains how Medicaid and dental care work.
Understanding Dental Care With Medicaid at Penn Dental Medicine
While Medicaid has certain mandatory benefits required by federal law, states have the choice of whether they’ll cover other optional benefits. Dental care falls in this optional benefit category.
In our tri-state area, Pennsylvania, New Jersey, and Delaware all have their own Medicaid plan. (It is also referred to as a medical assistance (MA) plan.) If you’re on Medicaid in these states, dental care coverage and limitations on services are as follows:
Pennsylvania Medicaid Dental Coverage
Medicaid-covered dental services for adults in Pennsylvania are those dictated by medical necessity for certain symptoms and emergency services, including:
- Exams and X-rays.
- Preventive dental care.
- Amalgam and composite restorations.
- Extractions and other oral surgeries.
- Palliative treatment for pain and symptoms.
Medicaid limits diagnostic and preventive services to once every 180 days per adult recipient. Additional evaluations, cleanings, and dental procedures, including root canals and crowns, require approved exceptions. It will cover one set of dentures per lifetime, but it doesn’t cover implants or adult orthodontics.
Children covered by Medicaid and the Children’s Health Insurance Program (CHIP) in Pennsylvania can access dental services, including:
- Teeth cleaning.
- X-rays.
- Cavity fillings.
- Crowns and other services.
If you have questions about your dental care options under Pennsylvania Medicaid, contact your local County Assistance Office (CAO).
New Jersey Medicaid Dental Coverage
In New Jersey, adults and children enrolled in Medicaid are eligible for dental services through NJ FamilyCare.
NJ FamilyCare, which also includes New Jersey’s CHIP, provides free or low-cost dental coverage to qualifying residents of any age, including uninsured children and pregnant women with income above the Medicaid eligibility limits.
Dental services include:
- Two exams and cleanings per year.
- Restorations and crowns.
- Root canals.
- Periodontal services.
- Oral surgical services.
- Medically necessary orthodontics to age 21.
- Medically necessary dental services in an operating room.
- Complete and partial dentures.
If you have questions about coverage or eligibility, NJ FamilyCare provides a helpful FAQ. You can also call NJ FamilyCare at 1-800-701-0710 (TTY: 711) and speak to a health benefits coordinator.
Delaware Medicaid Dental Coverage
Adults and children on Medicaid in Delaware can get dental services through the Children’s Dental Program and the Adults Dental Program.
Adults have access to:
- Preventative care: Exams, cleaning, X-rays, and sealants.
- Basic restorative care: Fillings and extractions.
- Limited periodontics care: Scaling, debridement, and maintenance.
Children have access to:
- Preventative care: Exams, cleaning, X-rays, fluoride (every six months), and sealants.
- Restorative care: Fillings, crowns, root canals, extractions, partials, and dentures.
- Orthodontics: Examination by an orthodontist and orthodontic records.
- Limited and comprehensive orthodontics are only covered when criteria are met.
- Braces are not covered for cosmetic reasons.
For coverage questions, check out Delaware’s Program FAQ. For questions about the children’s program, call 1-800-999-3371, and for questions about the adult program, call your managed care provider (page 4 of the FAQ above).
Does Medicaid Cover Dental Care at Penn Dental Medicine?
For Pennsylvania residents, yes. We accept all Medicaid plans offered to residents of Southeastern Pennsylvania at our locations at the University of Pennsylvania School of Dental Medicine (at 240 South 40th St., Philadelphia) and our facility in the former Mercy Philadelphia Hospital building at 54th Street and Cedar Avenue in Cobbs Creek.
Unfortunately, Medicaid plans from New Jersey or Delaware have their own eligibility requirements that don’t transfer from state to state unless you need emergency care.
However, our goal at Penn Dental Medicine is to keep costs from being a barrier to dental care. We make comprehensive dental care available to underserved populations through our unique teaching clinics that allow student dentists to practice and develop their skills under the instruction and guidance of the University of Pennsylvania School of Dental Medicine.
With fees reduced by as much as 50%-70%, you can get high-quality care at an affordable price, even if your state’s Medicaid plan can’t be used in Pennsylvania. Read more about our fees and how we work with most insurance plans here.
Take Advantage of Affordable Dental Care Options Available to You
With Penn Dental Medicine in Pennsylvania and many provider options in Delaware and New Jersey, you can get the dental care you need if you’re on Medicaid in the tri-state area.
Learn more about our low-cost services in our free eBook, Dental Work Without the Stress, which you can download here.
And, if you’re a Pennsylvanian on Medicaid, call 855-887-9229 and press 2 for Dental and then 2 for PDM at PHMC on Cedar, Monday through Friday, 9 a.m. – 5 p.m. or email us at cedardental@phmc.org to schedule a visit or get answers to your questions about how we work with Medicaid—for you. We look forward to talking to you soon.
