Copay relief portal11/12/2023 ![]() States must consult with recognized dental organizations involved in child health care to establish those intervals. Dental services may not be limited to emergency services for children entitled to EPSDT.ĭental services must be provided at intervals that meet reasonable standards of dental practice, and at such other intervals, as indicated by medical necessity, to determine the existence of a suspected illness or condition. If a condition requiring treatment is discovered during a screening, the state must provide the necessary services to treat that condition, whether or not such services are included in a state's Medicaid plan.Įach state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health care. The EPSDT benefit requires that all services must be provided if determined medically necessary. A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state.ĭental services for children must minimally include: Though oral screening may be part of a physical exam, it does not substitute for a dental examination performed by a dentist. Medicaid covers dental services for all child enrollees as part of a comprehensive set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. See the 2010 Medicaid/CHIP Oral Health Services fact sheet for information on children's access to dental services and opportunities and challenges to obtaining care. States are required to provide dental benefits to children covered by Medicaid and the Children's Health Insurance Program (CHIP), but states choose whether to provide dental benefits for adults.
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