Advancing innovations in health care delivery for low-income Americans | www.chcs.org SEPTEMBER 2019
Medicaid Adult Dental Benefits Coverage by State
This document is a companion to the fact sheet, Medicaid Adult Dental Benefits: An Overview, which outlines states’ coverage of dental benefits for adults in Medicaid. It also highlights
key challenges related to oral health care access and use for low-income adults, as well as opportunities for states to increase oral health care coverage and access for this population.
Assumptions
Following are several items to keep in mind when reviewing this document:
• If an annual expenditure cap is not explicitly stated, then no cap exists within the state.
• If a service is only available to a subset of the Medicaid population (e.g., pregnant women), it was not considered when determining the state’s level of benefit.
• If a dental plan is the only source listed, it is the only plan available for beneficiaries.
• As possible, news articles are only included as secondary sources.
State Benefit
1
Description Source(s)
Alabama None “Medicaid does not cover any type of dental care for adults.” www.medicaid.alabama.gov/content/4.0_Programs/4.2
_Medical_Services/4.2.2_Dental.aspx
Alaska
Emergency
“Adults (age 21 and over) — Coverage for Medicaid eligible adults who are 21 years and older includes
$1,150 annually for preventive dental care such as exams and cleanings, fillings, crowns, root canals and
dentures. All preventive Adult services require prior authorization. Emergency treatment for the relief of
pain and acute infection do not count against the annual cap.”
http://dhss.alaska.gov/dph/wcfh/Pages/oralhealth/faq.a
spx
“Enhanced adult dental services provide preventive and restorative care. Covered services include
cleanings, exams, crowns, root canals, and dentures.”
http://dhss.alaska.gov/dhcs/documents/pdf/recipient-
handbook.pdf
“After Gov. Mike Dunleavy vetoed $50 million from the state's Medicaid budget last week, some Alaskans
are already starting to feel the effects. A large chunk of those cuts — $27 million — eliminates dental
benefits for adults on Medicaid that in 2018 included approximately 30,000 Alaskans. The state said
services to children on Medicaid are not impacted by the budget cuts and that adults who need emergency
care for immediate relief of pain or acute infection will still be covered.”
www.ktva.com/story/40738058/alaskans-lose-medicaid-
dental-benefits-after-dunleavy-budget-cuts
Arizona
Emergency “Previously ALTCS and Tribal ALTCS members had a $1,000 benefit per member, per contract year to cover
medically necessary diagnostic, therapeutic, and preventative care services (this included dentures). Now
ALTCS and Tribal ALTCS members also have a $1,000 benefit per member, per contract year to cover
emergency dental care and extractions. Overall they now have $2,000 per year, but the allotments are
separated out into the two categories: 1) $1,000 for diagnostic, therapeutic and preventative care and 2)
$1,000 for emergency dental care and extractions." – “AHCCCS members 21 years of age and older have a
$1,000 dental benefit per member, per contract year to cover emergency dental care and extractions.”
www.azahcccs.gov/Resources/Downloads/DFMSTrainin
g/2018/DentalUpdates.pdf
1
Benefit definitions: (1) Emergency-Only: Relief of pain under defined emergency situations. (2) Limited: Fewer than 100 diagnostic, preventive, and minor restorative procedures recognized by the American Dental Association
(ADA); per-person annual expenditure for care is $1,000 or less. (3) Extensive: A comprehensive mix of services, including more than 100 diagnostic, preventive, and minor and major restorative procedures approved by the
ADA; per-person annual expenditure cap is at least $1,000.
Medicaid Adult Dental Benefits Coverage by State
Advancing innovations in health care delivery for low-income Americans | www.chcs.org 2
State
Benefit
1
Description
Source(s)
Arkansas
Limited
“For adults: Medicaid will pay up to $500 a year for most dental care, from July 1 to June 30. This includes
one office visit, one cleaning, one set of x-rays and one fluoride treatment. If your dentist says you need it,
Medicaid will pay for: (a) simple tooth pulling; (b) surgical tooth pulling (if Medicaid approves it first); (c)
fillings; and (d) one set of dentures (if Medicaid approves it first). Fees to the Dental Lab for dentures and
tooth-pulling do not count toward your $500 limit, but you can only get one set of dentures or partial
dentures in your lifetime. It’s up to you to make sure Medicaid will pay for other dental care if you need it.”
https://medicaid.mmis.arkansas.gov/Beneficiary/Covere
d.aspx#DentalCare
California
Extensive
If shown to be medically necessary, services can go beyond the yearly $1,800 limit. See source for list of
covered services.
www.dhcs.ca.gov/services/Documents/MDSD/Adult_Re
sto_FAQ-Fact_Sheet_12-2017.pdf
Colorado Extensive In 2013, the state legislature passed Senate Bill 242 which authorized the Department to create a limited
dental benefit in Health First Colorado for adults age 21 and over. Effective July 1, 2019, adult members
receive up to $1,500 in dental services per state fiscal year. This is an increase from the previous $1,000
cap. See source for list of covered services.
www.colorado.gov/pacific/sites/default/files/Adult%20H
ealth%20First%20Colorado%20Dental%20Benefit%20Fa
ct%20Sheet.pdf
Connecticut Extensive
“There is going to be a change to your adult dental benefits. There will be an annual adult dental benefit
maximum of $1,000. It will start 1/1/2018. This change is for everyone on HUSKY Health who is 21 years of
age or older.” However, there is no change to the services being offered.
www.ctdhp.com/documents/Adult_Dental_Final_Englis
h_2017-12-12.pdf
See source for list of covered services. www.ctdhp.com/documents/Dental%20Coverage%20Li
mitations%20By%20Program%20-%20client.pdf
Delaware None “Delaware is one of only three states without adult dental coverage.” https://dhss.delaware.gov/dhss/files/dhsspublicbudgeth
earing2020.pdf
“Dental procedures for members over twenty years of age are NOT covered in any setting. Dental services
include any services related to the dental treatment such as drugs, anesthetics, and use of
operating/recovery room, etc.”
https://medicaidpublications.dhss.delaware.gov/dotnet
nuke/DesktopModules/Bring2mind/DMX/Download.asp
x?Command=Core_Download&EntryId=897&language=
en-US&PortalId=0&TabId=94
District of
Columbia
Extensive “DC Medicaid provides a comprehensive dental benefit for children and adults. Adult services are provided
through our Fee-For-Service program and two cleanings per year are covered as well as all amalgams or
restorative fillings.”
www.dc-
medicaid.com/dcwebportal/providerSpecificInformation
/recipientFaqs
Florida
Emergency Emergency-based dental services covered only. https://ahca.myflorida.com/medicaid/Policy_and_Qualit
y/Quality/clinical_quality_initiatives/oral_health/index.s
html
Georgia
Emergency
“Adult Medicaid participants may qualify for dental services if it is life threatening or in an emergency
room, but this is on a case-by-case basis.”
https://georgia-assistance.org/georgia-health-
services/medicaid/medicaid-dental-insurance/
Hawaii Emergency "Adults (21 years old and above) can receive emergency benefits to control dental pain and infection." https://www.hawaiidentalservice.com/plans/medicaid
Idaho
Extensive “All Medicaid eligible adults (21 and older), regardless if they are on the Pregnant Women's Plan or Basic
Plan, have full access to the Medicaid Enhanced Plan dental benefits as of July 1, 2018.”
https://healthandwelfare.idaho.gov/Medical/Medicaid/
MedicalCare/DentalServices/tabid/696/Default.aspx
Medicaid Adult Dental Benefits Coverage by State
Advancing innovations in health care delivery for low-income Americans | www.chcs.org 3
State
Benefit
1
Description
Source(s)
“Preventive and diagnostic benefits, including: dental cleanings, exams and x-rays, and more. Therapeutic
benefits to treat cavities, gum or tooth pain, or other dental problems including: fillings, extractions,
dentures, and more.”
www.mcnaid.net/en/members-faq#c1-q2
Illinois Extensive “Most of the 1.7 million adults in the state’s Medicaid program already get coverage for preventive dental
services through managed-care organizations (MCOs). The MCOs have voluntarily paid dental offices for
preventive services such as cleanings and sealants but haven’t been specifically reimbursed for those
services, Johnson said. MCOs will receive reimbursement for preventive dental care going forward, but the
legislation will have the biggest immediate impact on the 450,000 adult Medicaid recipients who aren’t in
managed care, Johnson said. These adults are in the traditional “fee-for-service” Medicaid program. For
them, preventive dental services were treated as uncovered. As a result, they have had to pay much more
than $3.90 — the current Medicaid co-payment, when applicable — for cleanings and checkups, Johnson
said.”
www.sj-r.com/news/20180617/illinois-to-fund-
medicaid-preventive-dental-services-for-adults
Indiana
Limited “In Indiana, HIP Basic (coverage program under Indiana's Section 1115 waiver) does not cover dental
services.”
www.kff.org/medicaid/state-indicator/dental-
services/?currentTimeframe=0&sortModel=%7B%22colI
d%22:%22Location%22,%22sort%22:%22asc%22%7D#n
ote-1
“The HIP Plus program provides comprehensive benefits including vision, dental and chiropractic services
for a low, predictable monthly cost.”
www.in.gov/fssa/hip/2452.htm
Iowa Extensive “All Dental Wellness Plan members will receive full dental benefits in their first year of eligibility.” Must
meet healthy behavior measures in order to keep benefit. Cap of $1,000—but that doesn’t apply to most
services.
https://dhs.iowa.gov/dental-wellness-plan/benefits
Kansas Limited “Dental care for children and some preventative dental care for adults.” www.kancare.ks.gov/consumers/benefits-services
See source for list of covered services.
www.kancare.ks.gov/docs/default-
source/Consumers/choosing-a-plan/vas-ony-2018-
revised-3-2018.pdf?sfvrsn=56c84d1b_6
Kentucky Limited “Coverage for adults is limited, but includes: oral exams, emergency visits, x-rays, extractions, and fillings.” https://chfs.ky.gov/agencies/dms/dpo/bpb/Pages/denta
l.aspx
Louisiana
Limited
“We offer dental benefits for adults. Diagnostic benefits, including exams and x-rays. Prosthodontic
benefits, including complete and partial dentures.”
www.mcnala.net/en/about-program
Maine
Emergency Covered services limited to surgery, extraction, and treatment to relieve pain, eliminate infection, or
prevent imminent tooth loss.
www.maine.gov/dhhs/audit/rate-
setting/documents/S25P080910.pdf
Maryland None “Extractions are not covered in adult dental emergency department situations – emergency rooms are
unable to treat the causes of dental pain, so they treat the symptoms and send patients home with
antibiotics, pain medications, or referrals.”
E-mail with MD Action Coalition
Massachusetts Extensive “MassHealth members aged 21 and older are eligible for dental services performed by a MassHealth
dentist. Adult members who are determined by the Department of Developmental Services (DDS) to be
DDS Clients receive a different dental benefit package than Adults who are not DDS Clients.” See source for
list of covered services.
www.mass.gov/files/2017-08/MassHealth-Dental-
Member-HandBook_1.pdf
Medicaid Adult Dental Benefits Coverage by State
Advancing innovations in health care delivery for low-income Americans | www.chcs.org 4
State
Benefit
1
Description
Source(s)
Michigan
Limited
“The Healthy Michigan Plan covers: dental check-ups, teeth cleaning, x-rays, fillings, tooth extractions,
dentures, and partial dentures.”
www.michigan.gov/documents/mdch/Healthy_Michiga
n_Handbook_Final_447363_7.pdf
Minnesota
Limited “All covered services must be medically necessary, appropriate and the most cost effective for the medical
needs of the patient. “Clinical oral evaluations, preventive services, restorative, endodontics, periodontics,
and prosthodontics. Prior authorization and duration limits exist for certain services.
www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYN
AMIC_CONVERSION&RevisionSelectionMethod=LatestR
eleased&dDocName=DHS16_148070#non
Mississippi
Limited
“Covered services also include: dental extractions and related treatment.” $3 copay per visit.
https://medicaid.ms.gov/wp-
content/uploads/2019/03/Covered-Services-for-full-
Medicaid-benefits.pdf
Missouri
Limited
“Missouri’s state legislature in 2016 extended adult Medicaid dental benefits, including exams, X-rays,
cleanings, scaling and root planing, fillings and extractions.”
www.ada.org/en/publications/ada-news/2018-
archive/november/medicaid-success-in-missouri
“Services are limited for adults who are not in a category of assistance for pregnant women or the blind.”
https://mydss.mo.gov/msmed
Montana Extensive “Adult members with Standard Medicaid Benefits will have an annual $1,125 dental treatment services
cap; Covered Anesthesia, dentures, diagnostic, and preventative services do not count towards the annual
cap. Periodic service limits apply.” See source for list of covered services.
https://dphhs.mt.gov/MontanaHealthcarePrograms/De
ntal
Nebraska
Limited “Dental coverage is limited to $750 per fiscal year for individuals aged 21 years and older.” See source for
list of covered services.
file:///C:/Users/mpucciarello/Downloads/MCNA_mh-ne-
en-v1.1.pdf
Nevada Emergency “For adults, those residents 21 years of age and older, it only covers emergency dental examinations and
extractions, and in some instances false teeth (full and partial dentures to replace missing teeth).”
https://oralhealthnevada.com/oral-health-
resources/find-a-dental-provider/
New Hampshire
Emergency
“The Senate voted Thursday to remove the prohibition against adult dental care under the Medicaid
program and establish a working group to determine how to implement the benefit.”
www.seacoastonline.com/news/20190418/nh-senate-
votes-to-expand-medicaid-dental
“Treatment of severe trauma in an emergency.” https://familiesusa.org/sites/default/files/product_docu
ments/OH_Emergency-Oral-Health_Issue-Brief.pdf
“Another innovation creates a commission to craft a “value-based” dental care program for all Medicaid
recipients that focuses on better outcomes at lower taxpayer costs. The measure includes preventative
dental care. Previously, dental coverage for adults on Medicaid was limited to the treatment of infection
and severe pain. This bill directs the Department of Health and Human Services to develop a
comprehensive plan to ensure that Medicaid recipients can safeguard their smiles and their overall
health.”
www.unionleader.com/news/politics/state/medicaid-
service-upgrades-become-nh-law/article_72374283-
d234-5731-a1ae-8ae845053db1.html
New Jersey Extensive “NJ FamilyCare’s benefits include the nation’s longest running uninterrupted comprehensive dental
benefit.” See source for list of covered services.
www.nj.gov/humanservices/dmahs/boards/maac/MAA
C_Meeting_Presentations_4_13_17.pdf
New Mexico
Extensive
www.kff.org/medicaid/state-indicator/dental-
services/?currentTimeframe=0&sortModel=%7B%22colI
d%22:%22Location%22,%22sort%22:%22asc%22%7D
Medicaid Adult Dental Benefits Coverage by State
Advancing innovations in health care delivery for low-income Americans | www.chcs.org 5
State
Benefit
1
Description
Source(s)
See source for list of covered services.
www.medicaidinnovation.org/_images/states/New_Me
xico_Fact_Sheet_FINAL.compressed_.pdf
New York Extensive No spending limit; covers preventive, periodontal, dentures, and oral surgery services. No orthodontia. www.macpac.gov/wp-
content/uploads/2015/06/Medicaid-Coverage-of-
Dental-Benefits-for-Adults.pdf
North Carolina Extensive No spending limit; covers preventive, periodontal, dentures, and oral surgery services. No orthodontia. www.macpac.gov/wp-
content/uploads/2015/06/Medicaid-Coverage-of-
Dental-Benefits-for-Adults.pdf
North Dakota
Extensive “Covers exams, X-rays, cleaning, fillings, surgery, extractions, crowns, root canals, dentures (partial and full)
and anesthesia.” North Dakota does not offer adult dental benefit to its Medicaid expansion population.
www.nd.gov/dhs/services/medicalserv/medicaid/covere
d.html
Ohio Extensive Other than braces, adults are privy to the same services as children. See source for list of covered services. https://medicaid.ohio.gov/FOR-OHIOANS/Covered-
Services#1685616-root-canals
Oklahoma
Emergency
Emergency extractions only.
www.okhca.org/individuals.aspx?id=516&menu=48&par
ts=7461_7459
Oregon Extensive See source for list of covered services.
www.oregon.gov/oha/HSD/OHP/Tools/Covered%20and
%20Non-
Covered%20Dental%20Services,%20Effective%20Januar
y%201,%202019.pdf
Pennsylvania Limited “The dental services you may get are based on your eligibility category, age and need. Medical Assistance
covers all medically necessary dental services for enrolled children. This includes teeth cleaning, x-rays,
cavity fillings, crowns and other services. Adults enrolled in MA are eligible at a minimum for surgical
procedures and emergency services related to treatment for symptoms and pain. Some adults may be
eligible for other dental services.”
www.dhs.pa.gov/citizens/healthcaremedicalassistance/d
entalinformationforrecipientsandtheirfamilies/index.htm
Rhode Island
Extensive Lists off umbrella eight categories of dental services covered. Doesn’t cover orthodontic or general
anesthesia services. See source for list of covered services.
www.eohhs.ri.gov/Portals/0/Uploads/Documents/Denta
l_Benefits_for_Adults_%202007.pdf
“Beginning in January 2014, all Rhode Island adults with incomes at or below 138% of the federal poverty
level became eligible through the ACA for Medicaid that includes a comprehensive adult dental benefit,
with diagnostic, preventive, restorative, periodontal, surgical, prosthetic, and limited endodontic services.”
www.rimed.org/rimedicaljournal/2017/10/2017-10-51-
health-zwetchkenbaum.pdf
South Carolina Limited “These new services are available to members age 21 and older who have full Healthy Connections
Medicaid benefits. There is a $3.40 copayment for adult Healthy Connections Medicaid members toward
the cost of preventive care. The new benefit does not cover crowns, root canals, periodontal scaling and
root planing, teeth whitening or dentures.”
www.scdhhs.gov/press-release/healthy-connections-
now-provides-adult-dental-benefits
South Dakota
Limited
“Adult dental coverage is limited to $1,000 each year (July 1 – June 30). Recipients must pay for services
over the $1,000 yearly limit. Medically necessary emergency services, dentures, and partials are exempt
from the $1,000 limit.” See source for list of covered services.
https://dss.sd.gov/medicaid/recipients/dental.aspx
Tennessee No
coverage
TennCare does not cover adult dental. www.tn.gov/content/dam/tn/tenncare/documents/ben
efitpackages.pdf
Medicaid Adult Dental Benefits Coverage by State
Advancing innovations in health care delivery for low-income Americans | www.chcs.org 6
State
Benefit
1
Description
Source(s)
Texas
Emergency
Texas Medicaid provides emergency coverage.
Coverage type confirmed by the Texas Oral Health
Coalition via e-mail correspondence.
Utah
Emergency “Non-pregnant adults only have limited emergency dental benefits.” https://health.utah.gov/umb/benefits/medicaid/dental.
php
Vermont Limited “The dental benefit is limited to $510.00 per beneficiary per calendar year. Non-covered services include;
cosmetic procedures; and certain elective procedures, including but not limited to: bonding, sealants,
periodontal surgery, comprehensive periodontal care, orthodontic treatment, processed or cast crowns
and bridges. Prior authorization is required for most special dental procedures.”
www.greenmountaincare.org/health-
plans/medicaid#Dental
Virginia
Emergency
“Services for adults are limited to medically necessary treatments.”
www.dmas.virginia.gov/#/dentalservices
Washington
Extensive
Apple Health (Medicaid) pays for covered dental services for adults (21 years and older). Services not
covered: bridges, crowns, implants, and orthodontics. See source for list of covered services.
www.hca.wa.gov/health-care-services-supports/apple-
health-medicaid-coverage/dental-services#dental-
services-for-adults
West Virginia Emergency “Orthognathic surgical procedures with orthodontic treatment is covered even if the member exceeds the
21 years of age restriction AND the needed surgery is documented in the original orthodontic plan of care
and request. Orthodontic services require prior authorization from the UMC regardless of primary
insurance.”
https://dhhr.wv.gov/bms/Provider/LTC/Documents/Cha
pter%20505%20Dental,%20Orthodontics,%20and%20Or
al%20Health%20Services.pdf
Wisconsin
Extensive
States dental is covered through BagerCare+.
www.dhs.wisconsin.gov/badgercareplus/services.htm
Does not cover orthodontia, and some services require pre-approval; exam and cleaning limited to once
per year.
www.kff.org/medicaid/state-indicator/dental-
services/?currentTimeframe=0&sortModel=%7B%22colI
d%22:%22Location%22,%22sort%22:%22asc%22%7D
Wyoming Limited Limited preventive and emergency services – no restorative services.
https://health.wyo.gov/wp-
content/uploads/2018/02/Dental-Services.pdf
