Does Medicaid Cover Adult Dental Care? A State-by-State Guide

Last updated 2 months ago. Our resources are updated regularly but please keep in mind that links, programs, policies, and contact information do change.

For kids under 21, the answer is straightforward: yes. Federal law requires all state Medicaid programs to provide comprehensive dental services through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. This coverage is robust and designed to address any oral health issue found during a screening.

For adults 21 and over, everything changes. Federal law makes adult dental benefits optional. Each state decides whether to offer dental coverage, and if so, how much. The result is a complex patchwork where your zip code determines your access to dental care.

Coverage ranges from extensive benefits that rival private insurance to emergency-only plans that cover just tooth extractions. Some states offer no dental benefits at all for adults.

This guide explains why these differences exist, what the various coverage levels mean, and what services are covered in your state.

Why Every State Has Different Rules

The variation isn’t random. It stems from how Medicaid is structured as a federal-state partnership, the distinction between mandatory and optional services, and the economic pressures states face.

Who’s Really in Charge?

Medicaid launched in 1965 as a joint program between federal and state governments. It now covers over 71 million Americans, including low-income adults, children, pregnant women, elderly adults, and people with disabilities.

The federal government sets broad national standards that all participating states must follow. But each state runs its own unique Medicaid program. This flexibility lets states determine eligibility requirements, provider payment rates, and most importantly, which benefits they’ll offer.

This structure is why no two state Medicaid programs are exactly alike.

Mandatory vs. Optional: The Key Distinction

Federal law requires states to cover a core set of mandatory benefits. These include hospital care, physician services, lab work, and home health services. States have no choice but to provide these services.

Beyond this required floor, federal law lists optional benefits that states can choose to cover. If a state covers an optional benefit, the federal government provides matching funds, but states aren’t required to offer it. This category includes prescription drugs, physical therapy, eyeglasses, and adult dental services.

When states choose to cover optional benefits like adult dental care, they can define the “amount, duration, and scope” of that service. They can set limits on what’s covered, for how long, and under what circumstances.

This contrasts sharply with dental care for people under 21. For this group, dental services are mandatory under EPSDT. The standard is comprehensive, requiring states to provide any medically necessary service to “correct or ameliorate” a condition discovered during screening, regardless of whether that service is part of the adult Medicaid plan.

This creates a “coverage cliff” where comprehensive dental care can abruptly end or be severely curtailed on someone’s 21st birthday.

Follow the Money: How Budgets Shape Benefits

The decision to offer optional benefits like adult dental care heavily depends on state budgets and federal funding formulas. Medicaid is jointly funded, with the federal government paying a portion of state costs through the Federal Medical Assistance Percentage (FMAP).

FMAP is calculated annually based on a state’s average per capita income relative to the national average. States with lower incomes receive higher federal match rates. FMAP has a floor of 50% and ceiling of 83%. For fiscal year 2026, FMAP ranged from 50% in ten wealthier states, including California and New York, to 77% in Mississippi.

While federal funding is open-ended, states must provide their portion from their own revenues. Medicaid is typically a state’s second-largest expense after K-12 education.

This creates what’s called the “countercyclical squeeze.” During economic downturns, more people lose jobs and private health insurance, causing Medicaid enrollment and costs to rise. At the same time, state tax revenues decline as economic activity slows.

Faced with rising costs and falling revenue, state legislatures must balance budgets. Since they can’t cut mandatory benefits, optional benefits like comprehensive adult dental care are often the first to be reduced or eliminated.

This explains why states expand adult dental benefits during economic growth and cut them during recessions, creating instability for people who rely on these services.

Understanding Your Dental Benefits

Navigating Medicaid dental benefits requires understanding the terminology used by dentists and insurance plans. While definitions can vary by state, these are common categories of care.

Emergency Care

Emergency dental care generally means treatment for acute conditions requiring immediate attention to relieve severe pain, control bleeding, or eliminate infection. Examples include procedures for fractured jaws, dental abscesses, or traumatic injuries to teeth or gums.

The limited nature of this coverage creates a significant public health problem. When states offer only “emergency-only” benefits, they discourage preventive care. A small cavity that could be fixed with a simple filling is often left untreated until it becomes a painful abscess requiring extraction.

Without a regular dentist, many people turn to hospital emergency departments for relief. Hospital EDs aren’t equipped to perform definitive dental procedures like root canals; they can only manage symptoms with antibiotics or painkillers.

This approach is ineffective for long-term health and incredibly expensive for the healthcare system. Studies show these preventable ED visits for dental conditions cost the U.S. health system over $2 billion annually, with much of that cost avoidable if care had been delivered in a dental office.

Preventive Care

Preventive care focuses on maintaining good oral health and stopping diseases like cavities and gum disease before they start. This typically includes:

• Regular oral exams (check-ups)
• Teeth cleanings (prophylaxis)
• Routine X-rays
• Fluoride treatments

While these services are cornerstones of mandatory EPSDT benefits for children, their availability for adults is optional and varies by state.

Restorative Care

Restorative dentistry refers to procedures that repair or replace damaged or missing teeth to restore normal function. Insurance plans, including Medicaid, often divide this into two tiers based on complexity and cost:

Basic Restorative Services: More routine procedures to address common problems. This typically includes fillings to treat cavities and simple extractions (tooth pulling).

Major Restorative Services: More complex and expensive procedures. This includes root canals (to save infected teeth), crowns (caps placed over damaged teeth), bridges (to replace missing teeth), and dentures.

This distinction matters because even in states offering some restorative care, coverage may be limited to basic services. Major services like crowns and dentures often face stricter limitations, may not be covered at all, or require lengthy prior authorization.

“Medically Necessary”: The Most Important Phrase

“Medically necessary” is the standard used to determine coverage for many Medicaid services, especially complex or costly ones. There’s no single federal definition; each state establishes its own criteria.

For adult dental care, a procedure is typically deemed medically necessary if it’s required to treat a condition impacting overall health (like eliminating severe oral infection in someone with diabetes) or to restore essential functions like the ability to chew food properly.

This standard explicitly excludes procedures performed for purely cosmetic reasons, such as teeth whitening or correcting slightly crooked teeth. Understanding your state’s definition of medical necessity is key to knowing whether advanced treatments like braces or implants could ever be an option.

State-by-State Coverage Guide

The following guide provides comprehensive overview of adult dental benefits under Medicaid in all 50 states and the District of Columbia.

About Our Data

This information is based on the most current data from multiple sources. The primary framework for coverage levels comes from the CareQuest Institute’s “Medicaid Adult Dental Coverage Checker,” reflecting data self-reported by state Medicaid agencies as of December 31, 2023.

Medicaid dental benefits change constantly. Several states enacted or implemented expansions during 2024. Where this information is available from state announcements, legislative updates, and reports from organizations like KFF and the Center for Health Care Strategies, it’s included in “Recent/Upcoming Changes” notes.

Always verify current information with your state’s official Medicaid agency.

Coverage Categories Explained

Extensive: The state covers a broad range of services, including preventive, restorative (both basic and major), and emergency care. These states often have annual benefit limits of $1,000 or more, or no limit at all.

Limited: The state covers some preventive and/or basic restorative services but may exclude major procedures like root canals or crowns. These packages often have low annual spending caps, typically under $1,000.

Emergency-Only: Coverage is restricted to procedures addressing acute pain, infection, or trauma. In practice, this often means coverage is limited to tooth extractions.

None: The state provides no dental benefits for its general adult Medicaid population, though some coverage may be available for specific groups like pregnant women.

Quick Reference: Adult Dental Benefits by State

Data reflects coverage as of December 31, 2023, unless otherwise noted. “PA” means Prior Authorization required.

Detailed State Breakdowns

Alabama

Coverage Level: Emergency-Only

Alabama provides no dental benefits for its general adult population. Coverage is limited to pregnant women, who may receive some services. For all other adults, Medicaid doesn’t cover any type of dental care.

Key Exclusions: Preventive care, fillings, root canals, crowns, and dentures are not covered for the general adult population.

Find a Medicaid Dentist: Since services are highly restricted, contact the Alabama Medicaid Agency directly for guidance.

Alaska

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

Alaska provides comprehensive dental benefits for adults, covering exams, cleanings, X-rays, fillings, crowns, root canals, periodontal (gum) care, extractions, and dentures. Some services may require prior authorization.

Find a Medicaid Dentist: Use the InsureKidsNow.gov Dentist Locator, which serves adults as well as children.

Arizona

Coverage Level: Limited

Annual Benefit Limit: $1,000 per year for emergency dental care and extractions for general adults. Certain populations, like those in the Arizona Long Term Care System (ALTCS), have an additional $1,000 benefit for diagnostic, preventive, and therapeutic care.

General adults receive emergency exams and extractions to address pain and infection. ALTCS and other specific groups may also receive cleanings, fillings, and dentures.

Find a Medicaid Dentist: Use the Arizona Health Care Cost Containment System provider search.

Arkansas

Coverage Level: Limited

Annual Benefit Limit: $500 per fiscal year (July 1 – June 30).

The annual limit covers one office visit, one cleaning, one set of X-rays, and one fluoride treatment. Beyond that, Medicaid may pay for simple fillings and extractions. Dentures may be covered with prior authorization, and their lab costs don’t count toward the $500 limit.

Key Exclusions: Root canals and crowns are not covered. Dentures are limited to one set per lifetime.

Find a Medicaid Dentist: Visit the Arkansas Medicaid provider search portal.

California

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit. Some services may require prior authorization if total treatment cost exceeds $1,800 in a year.

California’s Medi-Cal Dental Program offers comprehensive benefits including exams, X-rays, cleanings, fillings, crowns (prefabricated and laboratory), root canals (front and back teeth), scaling and root planing, periodontal maintenance, and complete and partial dentures.

Key Exclusions: Dental implants are generally not covered. Orthodontics are covered only for children who qualify.

Find a Medicaid Dentist: Use the official Smile, California provider search tool or call 1-800-322-6384. Many beneficiaries are enrolled in managed care plans like Health Net and must use their plan’s directory.

Colorado

Coverage Level: Extensive

Annual Benefit Limit: $1,500 per state fiscal year.

Colorado’s Health First Colorado program offers strong benefits including exams, cleanings, fillings, crowns, root canals, periodontal services, extractions, and dentures.

Key Exclusions: Services exceeding the $1,500 cap are the patient’s responsibility. Some procedures require prior authorization.

Find a Medicaid Dentist: Use the Health First Colorado provider search.

Connecticut

Coverage Level: Extensive

Annual Benefit Limit: $1,000 per calendar year for most adults.

Connecticut’s HUSKY Health program provides comprehensive benefits including exams, cleanings, X-rays, fillings, crowns, root canals, extractions, and dentures.

Recent Changes: As of January 1, 2024, coverage expanded to include certain periodontal services for members with specific qualifying medical conditions, requiring prior authorization.

Find a Medicaid Dentist: Visit the CT Dental Health Partnership provider search.

Delaware

Coverage Level: Limited

Historically one of the few states with no adult dental benefit, Delaware added benefits in 2022. It covers preventive care (exams, cleanings, X-rays), basic restorative care (fillings, extractions), and limited periodontal care. Root canals and crowns are covered with limitations.

Key Exclusions: Implants and adult orthodontics are not covered.

Find a Medicaid Dentist: Use the Delaware Medicaid provider search tool.

District of Columbia

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

D.C. Medicaid provides comprehensive dental benefits including two cleanings per year, exams, X-rays, fillings, crowns, root canals, periodontal care, extractions, and dentures.

Find a Medicaid Dentist: Use the D.C. Medicaid provider directory.

Florida

Coverage Level: Emergency-Only

For adults 21 and older, Florida Medicaid covers only emergency-based dental services. This includes limited exams and X-rays for specific problems, extractions, and pain management. Dentures are covered, but routine preventive and restorative care is not.

Key Exclusions: Cleanings, fillings, root canals, and crowns are not covered for non-emergency situations.

Find a Medicaid Dentist: Most beneficiaries are enrolled in a managed care dental plan (DentaQuest, Liberty, MCNA). You must use your plan’s provider directory. General information is available at the Florida Medicaid managed care site.

Georgia

Coverage Level: Limited

Annual Benefit Limit: No annual dollar limit.

Georgia expanded benefits in 2022. Adults now have coverage for preventive services (cleanings, X-rays), fillings, and extractions. Limited periodontal and prosthodontic (denture) services are also available.

Key Exclusions: Root canals and crowns have significant limitations.

Find a Medicaid Dentist: Use the Georgia Medicaid Web Portal provider search.

Hawaii

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

Hawaii implemented a new, extensive adult dental benefit on January 1, 2023. It now covers X-rays, exams, cleanings, fillings, crowns, root canals, periodontal care, dentures, and extractions. This is a major improvement from its previous emergency-only benefit.

Find a Medicaid Dentist: Beneficiaries are enrolled in managed care plans. Contact your plan (AlohaCare, HMSA, Kaiser Permanente, UnitedHealthcare) for dental providers.

Idaho

Coverage Level: Limited

Annual Benefit Limit: No annual dollar limit.

Idaho provides a good range of services, including preventive care (cleanings, exams, X-rays) and therapeutic benefits like fillings, extractions, and dentures. Root canals and crowns are also covered.

Key Exclusions: The benefit may have frequency limits or require prior authorization for major services.

Find a Medicaid Dentist: Use the Idaho Medicaid provider search tool.

Illinois

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

Illinois provides comprehensive dental benefits for adults, covering preventive, restorative, periodontal, and prosthodontic services. This includes cleanings, fillings, root canals, crowns, and dentures.

Find a Medicaid Dentist: Use the provider search on the Application for Benefits Eligibility (ABE) website.

Indiana

Coverage Level: Limited

Annual Benefit Limit: Varies by plan.

Coverage depends on the specific Medicaid plan. The standard HIP Basic plan does not cover dental services. The HIP Plus plan, which requires a small monthly contribution, provides comprehensive benefits including vision and dental care. Other traditional Medicaid pathways also include dental benefits.

Key Exclusions: Access to dental care is contingent on being enrolled in a plan that includes it, like HIP Plus.

Find a Medicaid Dentist: Beneficiaries must use the provider directory for their Managed Care Entity (Anthem, CareSource, MHS, MDwise).

Iowa

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit (though a previous $1,000 cap existed, it doesn’t apply to most services).

The Iowa Dental Wellness Plan provides full dental benefits, including preventive, restorative, and major services like root canals and dentures.

Find a Medicaid Dentist: Beneficiaries choose a dental carrier (Delta Dental of Iowa or MCNA Dental) and must use that carrier’s provider network. Search tools are available on the Iowa HHS website.

Kansas

Coverage Level: Limited

Annual Benefit Limit: No annual dollar limit.

Kansas has incrementally expanded its adult dental benefit. As of 2023, it covers fillings, crowns, periodontal care, silver diamine fluoride, full and partial dentures, and denture repairs.

Recent Changes: Funding was approved to add coverage for dental exams and cleanings as a standard benefit, expected to start around July 1, 2024.

Find a Medicaid Dentist: Beneficiaries are enrolled in KanCare managed care plans (Aetna, Sunflower, UnitedHealthcare) and must use their plan’s dental network.

Kentucky

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

Kentucky significantly expanded its benefits in 2023. It now offers a comprehensive package including exams, cleanings, fillings, extractions, root canals, crowns, periodontal care, and dentures.

Find a Medicaid Dentist: Most members are enrolled in a Managed Care Organization. DentaQuest manages dental benefits for several plans. Find providers at the Kentucky Medicaid dental page.

Louisiana

Coverage Level: Limited

Annual Benefit Limit: No annual dollar limit.

Adult dental benefits include diagnostic services (exams, X-rays) and prosthodontics (complete and partial dentures). Some restorative and periodontal services are also covered, but coverage is not comprehensive. Specific waiver populations may have access to more extensive benefits.

Key Exclusions: Major restorative services like crowns and root canals are limited.

Find a Medicaid Dentist: Dental benefits are administered by DentaQuest and MCNA Dental. Members must use a provider in their plan’s network.

Maine

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

Maine implemented a comprehensive adult dental benefit in 2022. It covers preventive care, restorative services (fillings, crowns), endodontics (root canals), periodontics, extractions, and dentures.

Find a Medicaid Dentist: Use the MaineCare provider search tool.

Maryland

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

Maryland implemented a new, extensive adult dental benefit in 2023. It provides comprehensive coverage for services including exams, cleanings, fillings, root canals, crowns, extractions, and dentures. This replaced a previous system that offered no benefits to most adults.

Find a Medicaid Dentist: Use the Maryland Healthy Smiles Dental Program provider locator.

Massachusetts

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

MassHealth provides comprehensive dental services for adults, including preventive care, fillings, root canals, crowns, periodontal treatment, and dentures. Adults determined by the Department of Developmental Services (DDS) to be DDS Clients may receive an even broader package of benefits.

Find a Medicaid Dentist: Use the MassHealth dental provider search.

Michigan

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

Michigan expanded its benefits in 2023 and now offers a comprehensive package through its Healthy Michigan Plan and traditional Medicaid. Covered services include check-ups, cleanings, fillings, tooth extractions, root canals, crowns, and dentures.

Find a Medicaid Dentist: Beneficiaries are enrolled in Medicaid Health Plans and must use their plan’s provider directory. A search tool is available at the Michigan health plan finder.

Minnesota

Coverage Level: Limited (as of 12/31/23), now Extensive (as of 1/1/24)

Annual Benefit Limit: No annual dollar limit.

As of December 31, 2023, coverage was limited, with extensive benefits only available to specific populations like pregnant adults.

Recent Changes: A major expansion took effect on January 1, 2024. Minnesota now provides comprehensive dental benefits based on medical necessity to all Medicaid-enrolled adults, mirroring the benefit previously available only to children and pregnant women. This includes preventive, restorative, and major services.

Find a Medicaid Dentist: Use the Minnesota Department of Human Services provider directory.

Mississippi

Coverage Level: Emergency-Only

Adult dental coverage is limited to extractions and related treatments needed for pain relief or infection.

Key Exclusions: Preventive care, fillings, root canals, crowns, and dentures are not covered. There is a $3 copay per visit.

Find a Medicaid Dentist: Use the Mississippi Medicaid provider search tool.

Missouri

Coverage Level: Limited

Annual Benefit Limit: No annual dollar limit.

Missouri expanded benefits in 2022 to cover preventive services (exams, cleanings), restorative services (fillings, crowns), periodontal care, extractions, and dentures. Root canals are also covered.

Key Exclusions: Coverage is focused on services deemed medically necessary to treat pain, disease, and infection.

Find a Medicaid Dentist: Use the MO HealthNet provider search.

Montana

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit (a previous cap was removed).

Montana provides a comprehensive adult dental benefit, including preventive, restorative, and major services like crowns, root canals, and dentures.

Find a Medicaid Dentist: Use the Montana Healthcare Programs provider locator.

Nebraska

Coverage Level: Limited (as of 12/31/23), now Extensive (as of 1/1/24)

Annual Benefit Limit: $750 per fiscal year (as of 12/31/23). This limit was eliminated as of January 1, 2024.

Nebraska covers a wide range of services, including exams, cleanings, fillings, root canals, crowns, periodontal care, and dentures.

Recent Changes: Effective January 1, 2024, Nebraska eliminated its $750 annual benefit maximum, removing a significant barrier to care for those needing extensive treatment.

Find a Medicaid Dentist: Most members are in a Heritage Health managed care plan. You must use your plan’s provider directory.

Nevada

Coverage Level: Limited

Annual Benefit Limit: $750 per calendar year.

Coverage for adults includes emergency exams, extractions, and some restorative services. Full and partial dentures are also covered.

Key Exclusions: The low annual cap limits access to extensive treatment.

Find a Medicaid Dentist: Use the Nevada Medicaid provider search tool.

New Hampshire

Coverage Level: Extensive

Annual Benefit Limit: $1,500 per calendar year.

New Hampshire implemented a new, comprehensive adult dental benefit in 2023. It covers preventive care, fillings, extractions, root canals, crowns, periodontal care, and dentures.

Find a Medicaid Dentist: Use the NH Smiles Program provider search.

New Jersey

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

New Jersey has one of the nation’s longest-running comprehensive adult dental benefits. It covers a full range of services, including preventive, restorative, endodontic, periodontic, prosthodontic, and oral surgery services.

Find a Medicaid Dentist: Beneficiaries are enrolled in the NJ FamilyCare program. Use the provider search for your specific health plan.

New Mexico

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

New Mexico provides a comprehensive adult dental benefit, including exams, cleanings, fillings, root canals, crowns, and dentures.

Find a Medicaid Dentist: Use the New Mexico Medicaid provider search.

New York

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

New York offers an extensive dental plan. Historically strong, the benefit was further improved in early 2024 as the result of a lawsuit settlement.

Recent Changes: Effective January 31, 2024, coverage for crowns, root canals, and replacement dentures was significantly expanded to make it easier for members to access these services and keep their natural teeth.

Find a Medicaid Dentist: Use the NYS Medicaid Enrolled Provider Listing or call your Medicaid Managed Care plan.

North Carolina

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

North Carolina provides a comprehensive benefit package that includes preventive care, restorative services, periodontal care, dentures, and oral surgery.

Find a Medicaid Dentist: Use the NC Medicaid Provider and Health Plan Lookup Tool.

North Dakota

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

The state’s traditional Medicaid program covers a wide array of services, including exams, cleanings, fillings, crowns, root canals, and dentures.

Key Exclusions: North Dakota does not offer a dental benefit to its Medicaid expansion population.

Find a Medicaid Dentist: Use the provider directory on the North Dakota Health and Human Services website.

Ohio

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

Ohio provides a comprehensive dental benefit to all Medicaid beneficiaries. Covered services include checkups, cleanings, fillings, extractions, crowns, root canals, and dentures. There is a nominal copay (e.g., $3) for some services for adults.

Key Exclusions: Braces are only covered for individuals under 21 in extreme cases with prior authorization.

Find a Medicaid Dentist: Use the Ohio Department of Medicaid’s provider search tool or the national InsureKidsNow.gov locator.

Oklahoma

Coverage Level: Limited

Annual Benefit Limit: No annual dollar limit.

Oklahoma expanded its benefits in 2021. The state now covers preventive services (exams, cleanings), restorative services (fillings), periodontal care, and extractions. Dentures are also covered.

Key Exclusions: Coverage for major restorative services like crowns and root canals is limited.

Find a Medicaid Dentist: Beneficiaries are enrolled in SoonerCare. Use the provider directory.

Oregon

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

The Oregon Health Plan (OHP) provides a comprehensive dental benefit, covering exams, cleanings, fillings, crowns, root canals, dentures, and more.

Find a Medicaid Dentist: Use the OHP provider search tool.

Pennsylvania

Coverage Level: Limited

Annual Benefit Limit: No annual dollar limit.

Adult benefits are limited to services deemed medically necessary. This includes exams, X-rays, cleanings, fillings, extractions, and emergency treatment. Dentures are covered with limitations (one set per lifetime) and require prior authorization.

Key Exclusions: Root canals and crowns require approved exceptions and are not routinely covered. Implants and adult orthodontics are not covered.

Recent Changes: Legislation to expand coverage to include root canals and periodontal work passed the State House in late 2023 and is under consideration in the Senate.

Find a Medicaid Dentist: For HealthChoices (managed care) members, use your plan’s directory. For Fee-for-Service, use the provider search.

Rhode Island

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

Rhode Island provides a comprehensive adult dental benefit, including diagnostic, preventive, restorative, periodontal, surgical, and prosthetic services. Limited endodontic (root canal) services are also covered.

Key Exclusions: Orthodontics and general anesthesia are generally not covered for adults.

Find a Medicaid Dentist: Use the Executive Office of Health & Human Services provider directory.

South Carolina

Coverage Level: Limited

Annual Benefit Limit: $1,000 per fiscal year.

South Carolina expanded its benefit in 2022. The state now covers diagnostic, preventive, and basic restorative services up to the annual cap. Dentures and some periodontal services are also covered.

Key Exclusions: The previous benefit did not cover crowns or root canals; coverage for these may still be limited.

Find a Medicaid Dentist: Use the Healthy Connections Medicaid provider search.

South Dakota

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit (a previous cap was removed).

South Dakota expanded its benefits significantly in recent years and now offers a comprehensive package including preventive care, fillings, crowns, root canals, periodontal care, and dentures.

Find a Medicaid Dentist: Use the Department of Social Services provider search.

Tennessee

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

In a major policy shift, Tennessee implemented a comprehensive adult dental benefit through its TennCare program in 2023. It now covers exams, cleanings, X-rays, fillings, crowns, root canals, extractions, and dentures. Previously, the state offered no dental benefits to adults.

Find a Medicaid Dentist: Dental benefits are managed by DentaQuest. Members must use the DentaQuest provider directory.

Texas

Coverage Level: Emergency-Only

Texas Medicaid provides only emergency dental services for adults. This is generally limited to procedures necessary to control bleeding, relieve pain, and eliminate acute infection, which typically means extractions.

Key Exclusions: Routine preventive and restorative care, including cleanings, fillings, root canals, and dentures, are not covered for adults.

Find a Medicaid Dentist: For emergency services, contact your Medicaid managed care health plan. General resources can be found by calling 2-1-1 or visiting the Texas dental health finder. Dental plans like DentaQuest, MCNA, and UnitedHealthcare manage benefits for children and can be contacted for information.

Utah

Coverage Level: Limited

Annual Benefit Limit: No annual dollar limit.

As of late 2023, comprehensive dental benefits (including preventive, restorative, endodontic, and prosthodontic services) are provided only to specific adult populations: those with disabilities, those aged 65+, pregnant and postpartum women, and those in Targeted Adult Medicaid for substance use disorder. Other non-pregnant adults have limited emergency dental benefits.

Recent Changes: Legislation passed in 2023 requires the state to seek federal approval to expand the comprehensive dental benefit to all adult Medicaid beneficiaries. The implementation timeline is pending CMS approval.

Find a Medicaid Dentist: Use the Medicaid Adult Dental Provider List available on the Utah Medicaid website. Many members choose a dental plan (MCNA Dental or Premier Access) and must use that plan’s network.

Vermont

Coverage Level: Limited

Annual Benefit Limit: $1,500 per calendar year. The cap is eliminated for pregnant/postpartum adults and those in certain disability waiver programs.

Vermont covers a range of services including exams, cleanings, fillings, and root canals.

Recent Changes: In 2023, the annual benefit maximum was increased from $1,000 to $1,500. Coverage for medically necessary dentures was added for pregnant/postpartum adults and those in specific waiver programs.

Find a Medicaid Dentist: Use the Green Mountain Care provider lookup.

Virginia

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

Virginia launched a comprehensive adult dental benefit in 2021. The CardinalCare Smiles program covers a full range of services, including exams, cleanings, fillings, root canals, crowns, periodontal care, and dentures.

Find a Medicaid Dentist: Dental benefits are managed by DentaQuest. Members can find a provider using the DentaQuest search tool.

Washington

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

Washington’s Apple Health program provides a broad range of dental services for adults, including exams, cleanings, fillings, root canals, extractions, and dentures.

Key Exclusions: Services not covered include bridges, crowns on back teeth, and implants.

Find a Medicaid Dentist: Use the Health Care Authority’s Find a Doctor tool.

West Virginia

Coverage Level: Limited

Annual Benefit Limit: $1,000 per fiscal year.

West Virginia covers preventive services, fillings, root canals, extractions, and dentures, all subject to the annual cap.

Recent Changes: Effective July 1, 2024, the annual benefit maximum will change from $1,000 per year to $2,000 over a two-year period, allowing more flexibility for major procedures like dentures.

Find a Medicaid Dentist: Use the provider search on the Bureau for Medical Services website.

Wisconsin

Coverage Level: Extensive

Annual Benefit Limit: No annual dollar limit.

Wisconsin’s BadgerCare Plus program provides comprehensive dental benefits, including exams, cleanings, fillings, root canals, crowns, and dentures. Some services require prior authorization.

Key Exclusions: Orthodontia is not covered for adults.

Find a Medicaid Dentist: Use the ForwardHealth provider search.

Wyoming

Coverage Level: Limited

Annual Benefit Limit: No annual dollar limit.

Wyoming expanded its benefit in 2021. It now covers preventive services (exams, cleanings), fillings, extractions, and dentures.

Key Exclusions: Coverage for more complex services like root canals and crowns is limited.

Find a Medicaid Dentist: Use the Wyoming Medicaid provider search portal.

Common High-Cost Procedures: What’s Covered?

Beyond general coverage levels, many people want to know about specific, expensive dental treatments. Coverage for these procedures varies widely and almost always depends on the state’s benefit design and definition of “medical necessity.”

Does Medicaid Cover Dentures?

Coverage for dentures (full or partial) is a significant marker differentiating robust benefit packages from limited ones. As of 2022, a majority of states (31) and the District of Columbia provided some level of denture coverage for adults.

States with extensive benefit packages, such as California, New York, and Ohio, generally cover dentures. However, even in states offering this benefit, significant restrictions are common.

Prior authorization from the state Medicaid agency is almost always required before a dentist can proceed. Many states impose strict frequency limits, such as covering only one set of dentures per lifetime or once every 8 to 10 years.

In states with annual dollar caps on dental care, the high cost of dentures can easily exhaust a beneficiary’s entire yearly benefit. Some states, like Arkansas, help mitigate this by excluding laboratory fees for dentures from the annual spending limit, even though other services count toward it.

Does Medicaid Cover Root Canals?

Coverage for root canals is critical because it allows patients to save natural teeth rather than have them extracted. This is often a key difference between “limited” and “extensive” benefit packages.

Many states with limited benefits will authorize payment for an extraction but deny payment for a root canal on the same tooth, simply because extraction is less expensive in the short term.

In states that do cover root canals, coverage may be further restricted based on tooth location. For example, a state might cover a root canal on an anterior (front) tooth, which is highly visible, but not on a posterior (back) tooth like a molar.

States with extensive benefits, like New York, Ohio, and Florida (for those under 21), generally cover root canals on all teeth when deemed medically necessary to treat infection and save the tooth.

Does Medicaid Cover Braces for Adults?

For adults, Medicaid coverage for braces is exceptionally rare. The answer is almost universally no if the reason is cosmetic, such as correcting minor crowding or spacing.

The only path to coverage for adult orthodontics is meeting a state’s stringent definition of “medical necessity.” This is typically reserved for cases of “severe physically handicapping malocclusion,” where misalignment significantly impairs essential life functions like speaking, breathing, or chewing.

This may also include cases where orthodontics are necessary for larger surgical plans, such as correcting congenital deformities like cleft palate or preparing jaws for reconstructive surgery.

Even when conditions are severe, states may require demonstration that braces are the most cost-effective solution to the underlying health problem, creating a high bar for approval.

Does Medicaid Cover Dental Implants?

Coverage for dental implants under Medicaid is even rarer than coverage for adult braces. Most state Medicaid programs explicitly exclude dental implants, viewing them as elective or cosmetic procedures.

As with braces, the only potential route to coverage is proving profound medical necessity. This typically involves extensive documentation showing that an implant is required as a direct result of trauma (like an accident), a congenital condition (like ectodermal dysplasia where teeth are missing from birth), or as an integral part of larger medical treatment, such as jaw reconstruction following cancer surgery.

The beneficiary and their provider would also likely need to prove that an implant is the only viable or least costly long-term solution and that other options, like dentures or bridges, are not medically appropriate for that specific patient.

For the vast majority of adults who have lost teeth due to common decay or gum disease, Medicaid will not cover dental implants.

Navigating the System: Common Challenges

Securing dental benefits through Medicaid involves more than just knowing what’s covered. Beneficiaries often face significant real-world challenges, from finding a dentist who accepts their insurance to understanding their plan type.

The Provider Shortage Problem

One of the most significant barriers to care is the shortage of dental providers willing to participate in Medicaid. A person can have a Medicaid card that theoretically covers a wide range of services, but if there are no dentists in their area who accept it, the benefit is effectively useless.

There are two primary reasons for this shortage. First, reimbursement rates paid by state Medicaid programs are often substantially lower than what dentists receive from private insurance or charge cash-paying patients. These low payments can make it financially difficult for a private practice to treat Medicaid patients.

Second, dentists often cite significant administrative burdens, including complex billing procedures, cumbersome prior authorization requirements, and difficult credentialing processes, as deterrents to participation.

An American Dental Association analysis found that even among dentists technically enrolled in their state’s Medicaid program, a significant number don’t actively treat Medicaid patients or see very few.

Finding a Participating Dentist

Finding a dentist who accepts Medicaid requires persistence. Here’s a step-by-step guide:

Start with Your Plan: If your Medicaid coverage is through a Managed Care Organization (MCO) or specific dental plan (e.g., DentaQuest, MCNA Dental, Health Net), use that plan’s dedicated provider directory first. You’re required to see a dentist within your plan’s network. These directories are available on the plan’s website.

Use State-Specific Search Tools: If you’re in a Fee-for-Service plan or unsure of your plan, use your state’s official Medicaid provider search portal. These are often found on the state’s Department of Health or Medicaid agency website.

Use the National Search Tool: The Centers for Medicare & Medicaid Services provides a national dentist locator at InsureKidsNow.gov. Despite its name, this tool is the official resource for finding dentists who accept Medicaid and CHIP for both children and adults.

Call and Confirm: Provider directories can sometimes be out of date. Before your appointment, call the dental office directly. Confirm two things: 1) Are they currently accepting new Medicaid patients? and 2) Do they accept your specific Medicaid plan?

Explore Alternative Clinics: If you struggle to find a private practice, broaden your search to include Federally Qualified Health Centers (FQHCs), also known as community health centers, and dental school clinics. These facilities are a critical part of the healthcare safety net, often accept all Medicaid plans, and may offer services on a sliding fee scale for those without coverage.

Managed Care vs. Fee-for-Service

Medicaid services are delivered through two main systems, and knowing which one you’re in is crucial for accessing care.

Fee-for-Service (FFS): This is the traditional Medicaid model. The state Medicaid agency pays dentists directly for each individual service they provide to a beneficiary. In an FFS system, patients can generally go to any dentist enrolled with the state’s Medicaid program.

Managed Care Organization (MCO): This is the more common model today, with over half of all Medicaid spending flowing through MCOs. In this system, the state pays a private insurance company (the MCO) a fixed monthly rate (a “capitation” payment) for each enrolled beneficiary.

The MCO is then responsible for providing all covered health services by creating a network of doctors, hospitals, and dentists. Patients in an MCO plan must use a provider within that MCO’s network for services to be covered.

In some cases, MCOs may offer “value-added” benefits beyond what the state mandates to attract members, but these extra benefits aren’t guaranteed and can change from year to year.

How Medicaid Compares to Other Coverage

To fully understand the value and limitations of Medicaid’s adult dental benefits, it’s helpful to compare them to other major types of dental coverage in the United States: Medicare and private dental insurance.

Medicaid vs. Medicare

Medicaid and Medicare are often confused, but their approaches to dental care are vastly different.

Original Medicare (Part A and Part B), the federal health insurance program primarily for people 65 and older and younger people with certain disabilities, does not cover routine dental care. This is a significant coverage gap.

Medicare will not pay for cleanings, fillings, tooth extractions, dentures, or dental implants. Coverage is provided only in very limited situations where a dental service is considered integral to the success of a covered medical procedure, such as jaw reconstruction after an accident or an oral exam required before an organ transplant or heart valve replacement surgery.

Medicare Advantage (Part C) plans are an alternative to Original Medicare, offered by private insurance companies approved by Medicare. To compete for customers, over 90% of Medicare Advantage plans offer some dental coverage as an extra benefit.

However, this coverage is often not as comprehensive as it may seem. These plans typically have significant cost-sharing, such as 50% coinsurance for major services like root canals or crowns, and come with low annual benefit caps, averaging around $1,300.

Medicaid vs. Private Insurance

When compared to private dental insurance, such as plans offered by employers or purchased on the marketplace, Medicaid presents a clear trade-off between out-of-pocket costs and provider access.

The key distinctions are:

Cost to Enrollee: Medicaid has extremely low or no out-of-pocket costs, making it the most affordable option for those who qualify. Private plans involve consistent costs through premiums, deductibles, and coinsurance.

Provider Access: This is the primary advantage of private insurance, which generally offers much larger networks of participating dentists. Finding a dentist who accepts Medicaid remains a significant barrier to care for many beneficiaries.

Annual Limits: This is a major advantage for many Medicaid beneficiaries. In states with extensive benefits and no annual dollar cap, patients can receive necessary, high-cost treatment without fear of exhausting their benefits. Nearly all private plans have strict annual maximums, which can easily be exceeded by a single major procedure like a crown or bridge.

The Bottom Line

Medicaid dental coverage for adults remains a complex, state-by-state puzzle. While some states have embraced comprehensive coverage that rivals private insurance, others provide minimal or no benefits at all.

The coverage you receive depends entirely on where you live, creating significant disparities in access to oral healthcare across the country. These differences reflect broader debates about the role of government in healthcare, state budget priorities, and competing demands for limited public resources.

For the millions of Americans who rely on Medicaid, understanding these variations is crucial for making informed decisions about where to live, what care to seek, and how to navigate the system effectively.

Our articles make government information more accessible. Please consult a qualified professional for financial, legal, or health advice specific to your circumstances.