Does Maryland Medicaid Cover Dental Care?

By Medicare Benefits - December 22, 2020

Ever since 1965, Medicaid and Medicare have provided healthcare insurance to millions of Americans. Since its beginning, Medicaid’s main purpose has been to make healthcare available to individuals, families, children, pregnant women, seniors, and to people with disabilities who have few resources and low incomes. 

The Medicaid program is run by both the federal and state governments. Under federal law, Medicaid is required to provide a core set of health care services in every state. These mandatory services include inpatient and outpatient hospital care, physician’s care, laboratory and x-ray services, and home health services. 

State governments have the right to choose the optional benefits the Medicaid program can provide to beneficiaries who qualify and live in the state. Because dental care services are on this optional list of benefits, not all states provide them to adult Medicaid beneficiaries or to dual-eligibles. Dual-eligible recipients qualify for healthcare insurance from both Medicaid and Original Medicare. However, Medicaid does require all states to provide dental care services to children who are covered by Medicaid and the Children’s Health Insurance Program known as CHIP.

Does Maryland Medicaid cover dental health services?

Before June 1, 2019, Maryland Medicaid didn’t cover dental health services for adults (over the age of 21). The only exceptions were (and still are) for pregnant women, people who were in the Rare and Expensive Case Management and Emergency Services program, and for people who had dental emergencies in the hospital emergency department. 

Although a dental care pilot program has since been put in place, in the instance of hospital emergency room visits for dental problems, extractions are not included in the emergency care for adults. The hospital emergency room can only treat the symptoms of pain and can’t treat the cause. Physicians and nurses in the emergency room can give the patient antibiotics, pain medication, and refer them to another medical professional. 

In May of 2018, the Maryland senate passed a bill to create a pilot program for adult dental coverage through Maryland Medicaid beginning June 1, 2019. They did this to see if the health of vulnerable adults would improve through adult dental care benefits. Those who are eligible to take part in this program are dual-eligibles between the ages of 21 and 64. In Maryland, that means that around 38,510 people are eligible for this program. The dental services provided through this pilot program include the following:

• Oral surgery – extraction of an erupted tooth or an exposed root; surgical removal of an erupted tooth, removal of bone, sectioning of tooth; nitrous oxide, analgesia, anxiolysis

• Diagnostic oral examinations – one every six months for simple oral examination, one every 12 months for limited oral examination, and one every 36 months for a comprehensive oral examination 

• Preventive care – cleaning of permanent teeth once every six months

• Restorative care – one restoration (filling) per tooth surface every 36 months

For all of the above services, there are fees attached. These fees are not paid by the beneficiary, but they are only allowed to receive services up to $800.00 per year as long as the pilot program runs. 

This pilot program is valuable for dual-eligibles because Original Medicare Part B (medical insurance) does not cover routine dental care or procedures such as cleaning, fillings, or extractions. They do not cover dental supplies such as dental plates, partials, or dentures either. Original Medicare Part A (hospital insurance) only covers some dental services that you might need when you are a patient in the hospital. 

If you live in Maryland and would like to see if you are eligible for the Medicaid dental care pilot program, you can visit Maryland’s Department of Health website, or call a local CMS office and ask an agent for information. 

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