Medicaid is a federal program administered by states to ensure low-income Americans can access health care coverage. To qualify, you must have limited income and resources. In compliance with federal rules, each state determines the financial threshold and other eligibility requirements applicable to state residents. People enrolled in Medicaid include:
- Adults with limited means
- Pregnant women
- Elderly adults
- People with disabilities
Dental care for children with Medicaid
The Children’s Health Insurance Program (CHIP) is a low-cost health insurance program for children in families where the household income exceeds the level that would qualify them for Medicaid but falls below the level needed to purchase private insurance. CHIP is available in every state and partners with the Medicaid program.
Every state must provide access to dental coverage for every child covered by Medicaid and CHIP. All children enrolled in Medicaid get the comprehensive dental benefit known as Early and Periodic Screening, Diagnostic and Treatment (EPSDT). At minimum, states must provide dental services that include:
- Pain and infection relief
- Teeth restoration
- Dental health maintenance
Orthodontia (braces) falls under restorative services. However, coverage applies only if the braces are medically necessary. States can decline coverage for braces requested for cosmetic reasons.
According to the Louisiana Department of Health, Medicaid recipients up to and including age 20 who have “only crowded or crooked teeth, spacing problems or under/overbite are not covered for braces unless identified as medically necessary.”
People who qualify for both Medicaid and Medicare are sometimes called dual-eligibles. Benefits vary depending on whether you are among the full-benefit dual-eligibles (FBDE) or fall into one of the categories of partial dual-eligibles, such as:
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualifying Individual (QI)
- Qualified Disabled and Working Individuals (QDWI)
Dental care for adults with Medicaid
Medicaid does not require states to extend dental coverage to adults. Each state makes that determination. The majority of states offer emergency dental services, but fewer states cover comprehensive dental benefits.
Louisiana provides limited dental services to Medicaid recipients age 21 and over:
- Dental exam
- X-rays if needed to build dentures authorized by Medicaid
- Dentures, with specific limitations
Adults enrolled in QMB, SLMB and other programs with limited benefits are ineligible for dental services in Louisiana.
Dual Eligible Special Needs Program (D-SNP)
The Special Needs Plan (SNP) is a type of Medicare Advantage (MA) plan. If you have a disease, health care need or limited income, you may be eligible for an SNP. The SNP is distinguished from other MA plans in that it customizes benefits, provider options and formularies (approved drug lists) to serve the needs of its membership populations.
One of the groups that an SNP serves is dual-eligibles. Dual-eligibles are qualified to join a D-SNP, and a D-SNP is contractually obligated to coordinate your Medicaid and Medicare benefits.
- Louisiana Department of Health: 1-225-342-9500
- Healthy Louisiana: 1-855-229-6848