Medicaid Dental Insurance in Ohio
Establishing whether an individual is eligible for Medicaid dental insurance in Ohio is not always straightforward. Dental coverage under Medicaid is determined by numerous factors. Under federal law, Medicaid dental insurance eligibility requirements only guarantee dental services to children and young adults age 21 or younger. Medicaid dental coverage is not required to be extended to Medicaid-eligible adults, and is therefore provided at the discretion of individual states. Although Medicaid dental insurance in Ohio is not required by law to extend care to all Medicaid recipients, the Centers for Medicare & Medicaid Services recognize oral health as a key indicator of overall health, and advise states to promote oral wellness whenever possible to avoid the impaired quality of life Medicaid recipients experience when consistent and quality dental care is not provided. Read more about Medicaid dental coverage in Ohio in the below sections.
Ohio Medicaid Dental Insurance for Adults in Ohio
Despite the lack of legal requirement, Medicaid dental insurance in Ohio provides an extensive list of services to adult residents who are eligible for Medicaid benefits. For example, Ohio Medicaid dental insurance covers checkups and teeth cleanings conducted by participating dental providers for covered adults older than 21 years of age. Some of these recipients will be charged small copays for services rendered.
Adults eligible for Medicaid dental insurance in Ohio attempting to access many of the dental services and appliances potentially available to them once they have enrolled in Ohio Medicaid dental insurance will find that many of those products and services are restricted. The most common restriction is the determination of medical necessity. For example, under Ohio Medicaid dental insurance, dentures can only be replaced when a qualified and participating dental provider deems the replacement a medical necessity. In some cases, prior authorization of the product (e.g. dentures) to be replaced is required. Nominal copays are typically required for such special, authorized services and procedures. Some individuals eligible for Medicaid dental insurance in Ohio will be exempt from copays. Generally, exemptions are granted to defined sub-populations of Medicaid recipients, such as residents of assisted living facilities and enrollees with certain forms of disabilities.
Other services covered by Ohio Medicaid dental insurance for qualified adults for whom a participating provider has determined medical necessity include:
- Root canals.
- Fillings or crowns.
- Tooth extraction.
- Dental surgery.
All Medicaid dental oral care must be provided by qualified and participating dental providers. Furthermore, it must be performed in accordance with accepted standards of dental care. Where applicable, such care will be subject to review by and coordination through a patient's Medicaid managed care plan. Learn more about Medicaid dental services in our free, downloadable guide.
Medicaid Dental Coverage for Children in Ohio
Children and adults younger than 21 years of age that are eligible for Medicaid dental insurance in Ohio must be provided with Ohio Medicaid with dental coverage that aligns with Medicaid's Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. Enrollees younger than 21 years of age who are eligible for Medicaid dental insurance in Ohio must be provided with a complete list and schedule of services that comply with EPSDT standards. THE EPSDT places tremendous importance on screenings, early intervention services and preventative maintenance related to oral health. In addition to screenings and regular preventative care visits, children covered by Medicaid through the Children's Health Insurance Program (CHIP) are also mandated to receive Medicaid dental oral treatment with fluoride and specialty services, such as X-rays and dental sealant application.
Ohio Medicaid dental insurance is required to cover the cost of any medically necessary dental services, procedures or appliances uncovered or determined to be required by the screenings, checkups and other appointments required to meet EPSDT standards. Ohio Medicaid dental insurance includes pain relief and treatment of active infections. Under no circumstances may care for this population be restricted to emergency services. It is important to note that the determination of medical necessity in such cases is ascertained by the state.
The frequency of dental visits to qualified providers under Ohio Medicaid dental insurance is determined by a legally-mandated schedule developed by the state, in collaboration with approved organizations specializing in dentistry and standards of care. A referral to a dentist is required for every enrolled child, in accordance with each state's periodicity schedule and at other intervals as medically necessary. Although children and young adults enrolled in OH Medicaid dental insurance must be provided with referrals and opportunities to access care in every case specified under this schedule, the schedule does not prohibit or otherwise interfere with their ability to access appropriate dental care at any other time, as needed.
Medicaid Dental Insurance Eligibility Requirements and Enrollment
To enroll in OH Medicaid dental insurance does not require any application process separate or distinct from general Medicaid eligibility and enrollment. After learning how to apply for Medicaid in Ohio and being accepted for benefits, simply contact your managed care plan provider with questions about Medicaid dental insurance in Ohio, for assistance accessing your benefits or for help identifying and contacting qualified and participating providers.
Learn more about Ohio Medicaid by downloading our complimentary guide.