Families in the United States today increasingly experience financial barriers to quality oral health care and dental services more than any other type of healthcare, no matter what their age or annual income. It’s an especially complex issue to navigate for families with children, yet children are most in need of regular dental care.
For many of these parents and kids, Medicaid and other kinds of state-administered insurance programs are a crucial lifeline to getting the care they need and deserve. But if your local dentist doesn’t accept Medicaid, it can create serious barriers to care that are tough to overcome.
Fortunately, many pediatric dentists do take Medicaid, and that includes many of our partner dentists. Learn more about Medicaid and dental services on this page, then take a look through our partner directory to find a dentist near you. Whether it’s Medicaid, a major insurance carrier, some other state program or private financing, finding a flexible payment or coverage option that suits your needs is easier than ever.
Medicaid is a government-administered and funded program that provides health insurance coverage for individuals and families with low income and minimal resources. The federal government, in conjunction with the states, funds Medicaid and sets out eligibility criteria and guidelines.
The following populations might be eligible for Medicaid, depending on income and other factors:
Created in 1967, the Early Period Screening, Diagnosis and Treatment (EPSDT) program sets out care requirements was established in 1967, mandating dental care benefits under federal law to children covered by Medicaid. This mandate includes dental benefits beyond emergency dental care.
Under existing rules governing Medicaid, the program must provide coverage for the following dental services and care:
The staff at your pediatric or general dentistry practice should be able to tell you if the office accepts Medicaid.
The Children’s Health Insurance Program, an insurance program specifically for children in low-income households that’s operated by state governments, may be able to assist with coverage for dental care when the family income is too high to qualify for Medicaid.
Under CHIP guidelines, the following pediatric dentistry services and procedures are covered:
While the specific insurance policies accepted are up to each individual dental practice, many pediatric and family dentists want to provide quality dental care to families from all backgrounds and income levels. They know that affordable dental services are a must for all families and children, and so they’re happy to accept a variety of insurance plans and payment options, including:
Are you in the middle of the process of applying for Medicaid or some other government insurance program? If so, talk to one of our Kool Smiles partners about other payment arrangements, including the CareCredit credit card, which allows you to finance medical and dental services and pay off the balance in monthly installments.
Pediatric dentists have special experience putting nervous kids at ease while they care for their smiles and ensure their future oral health. With two to three years of specialized training in caring for children of all ages, a pediatric dentist can become a parent’s partner in ensuring great dental hygiene habits for life. They’ll explain the procedures to your child to eliminate surprises and help the child through the visit, and answer any questions you or your child might have afterwards.
An experienced pediatric dentist can also help soothe any existing anxiety a child might have about visiting the dentist. Many have toys and a dedicated area for play to keep young patients entertained while they wait and will even allow parents into the treatment room to make sure the child is comfortable. They may also use either nitrous oxide (commonly called laughing gas) or a local anaesthetic substance to minimize gum and tooth pain.
Children with special needs often experience obstacles to receiving necessary dental services. This in turn can put them at greater risk of oral health problems. Barriers to dental care can put children with special needs at increased risk for oral diseases.
Pediatric dentists have received specific training in treating children who have special needs, and are more likely to be able to successfully treat them. Children with certain developmental or behavioral challenges may struggle to cooperate with dental care providers, which in turn can increase the chance they might experience dental health problems. If the child is insured through Medicaid, it’s sometimes even more challenging to find the right dentist.
Kids with special needs are susceptible to many dental health problems conditions:
If your child has special needs, it’s important to find the right dentist who can care for your child and make you both feel at ease. Our partner pediatric dentists have the experience, advanced skills, and compassion that’s required to deliver high-quality dental care to your child, no matter what their age.
Medicaid rules allow coverage for services and procedures that your child’s dentist deems medically necessary, including those services for which a need is identified during a routine screening. This includes braces, if the misalignment of the teeth is damaging or impeding your child’s ability to bite, chew, swallow or speak.
Kool Smiles partners can cover your child’s needs for regular cleanings and basic dental services, as well as many more specialty services:
You and your children deserve a safe, skilled and compassionate dentist, whether the services you need are covered by Medicaid or not. Finding the right dentist for your family’s needs, however, can be a challenge.
You can start by asking other parents for recommendations of pediatric dentists who have treated their children successfully. Also look for independent online reviews through sites such as Yelp. Finally, don’t be afraid to ask the dentist’s office staff for information on qualifications, such as whether they have additional training or education, how long they’ve been in practice, and whether they adhere to the guidelines of the American Association of Pediatric Dentistry (AAPD).
Below find the answers to some commonly asked questions about pediatric dental services and Medicaid.
Not necessarily. The crucial thing is for your child to receive routine checkups. Regular visits can help avoid problems through scheduled cleanings, exams, X-rays, and where necessary treatment such as crowns and fillings.
Children who are covered by Medicaid may maintain coverage until they turn 21.
Regular checkups and routine care can help prevent more serious problems later on. When bigger issues do develop, those regular checkups can help identify them early for better treatment and positive outcomes. If your child needs specialized care, a general dentist can refer you to a pediatric dentist who accepts Medicaid to get the services they require.
Generally, insurance policies cover regular cleanings every six months. If your child receives more than one cleaning during a six-month period of time, insurance may not cover the cost.
First, it’s important to supervise young children when they brush and floss their teeth twice a day. Ensure they are seen by a pediatric dentist around their first birthday, and that they receive regularly scheduled examinations and tooth cleanings every six months. Finally, browse our Kool Smiles collection of resources, including lesson plans and other educational materials.
If you’re in search of a pediatric dentist in your location who accepts Medicaid and can provide the high-quality dental services your children and your family deserve, call one of our partner dentists today. Many accept Medicaid as well as other insurance plans, in addition to credit cards, cash and other financing options.
Your children and teens deserve compassionate care in a safe, pleasant and respectful environment. You deserve flexible payment options that suit your budget and needs. Our partner dentists can provide your family with both, ensuring great oral health and beautiful smiles for life. Start your search for a Kool Smiles partner near you today.
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Sources:
HealthAffairs.org: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2016.0800
Medicaid.gov: https://www.medicaid.gov/
American Academy of Pediatric Dentistry: https://www.aapd.org/assets/1/7/Medicaid2017-smallest.pdf
Medicaid: https://www.medicaid.gov/medicaid/benefits/dental/index.html
Healthcare.gov: https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/
National Center for Biotechnology Information: https://pubmed.ncbi.nlm.nih.gov/20478802/
WebMD: http://www.webmd.com/oral-health/guide/childs-first-dental-visit
InsureKidsNow.org: https://www.insurekidsnow.gov/find-coverage-your-family/frequently-asked-questions/index.html