Does Medicaid cover the costs of child health dental emergencies? This is a crucial question that most people ask themselves when it comes to attending a dental emergency with a Medicaid policy. Experts in the subject state that dental services are essential for those eligible under Medicaid under 21 years. This is mandatory under the EPSDT or Early and Periodic Screening, Diagnostic, and Treatment benefit in the USA.
What does the Medicaid Dentist do under the EPSDT Program?
The EPSDT is a comprehensive program under Medicaid for the health of children. The goal of this program is to prevent early diagnosis and treat medical conditions. The EPSDT is a compulsory service that falls under the Medicaid program of every State.
Under the supervision of a Medicaid dentist, these services should-
- Meet the desired standards for dental practice as laid down by the State
- Covers relief for tooth infections and pain, maintaining dental health, detecting the presence of a suspected condition or illness, and dental care maintenance.
- Dental care services are not only limited to emergencies for recipients of EPSDT benefits.
- These dental services must be provided at regular intervals to recipients under the EPSDT program of the State
How does the EPSDT program work for children?
The procedure involves an oral screening that might be a part of the physical examination; however, this will not substitute for a qualified dentist’s need for dental examinations as a direct referral.
This direct referral to a dentist is mandatory for each child keeping in mind the periodic schedule that has been laid down by the State. However, Medicaid and Medicare services do not define the specific services for dental care given to the child. The EPSDT states that all of the dental services covered by Medicaid should be given to recipients of the EPSDT program if they are deemed necessary medically.
Under Medicaid, the State will determine this medical necessity. Suppose there is a condition where treatment is needed, and it is discovered during an oral screening or physical examination. In that case, the State is under the obligation to treat the condition irrespective of whether the service is included in the State’s Medicaid plan.
What about people over the age of 21 years?
When it comes to adults of over 21 years of age, the State will decide whether it will offer dental care services to adults eligible under the Medicaid program.
With the help of a qualified dentist, most States offer emergency dental care services for their Medicaid eligible adult population, whereas less than 50% of the States offer comprehensive dental care. The dental coverage given to adults here does not have any minimum requirements.
When searching for a right Medicaid dentist, ensure the professional has proven track records of dental care experts, compassionate in approach, and friendly to make patients, both young and old, feel comfortable during any dental care or treatment procedure.