Does Medicaid Cover Dentures for Adults in Your State 2022

A seemingly simple question, “does Medicaid cover dentures for adults in 2022” can have a complicated answer.

First, the type of denture influences the answer because Medicaid acts primarily as health insurance and secondarily as dental insurance.

Second, thirty-three states pay for restorative care (false teeth) with several limitations, while seventeen others offer nothing.

Third, you will not find a reliable answer on the internet, and this article can only provide general guidance. The ultimate authority will be the private company administering claims for the type of dentures you need.

Finally, the Managed Care Organization or Dental Benefits Manager associated with your plan determines which claims to pay or reject.

When Does Medicaid Cover Dentures for Adults

The answer to whether Medicaid covers dentures for adults in 2022 has many layers and no single correct answer. The tax-payer-funded program has a dual nature affecting the kinds of false teeth covered.

  1. The health insurance component often pays for medically necessary services uniformly across the country when the problem originates elsewhere in your body
  2. The dental insurance element pays for the least expensive alternative in states supporting specific oral care benefits when the problems start in your teeth or gums

Dental grants for low-income adults could prove a superior avenue for people living in states without the needed restorative care benefits and those wanting an upgrade over the least expensive treatment.

Implant-Supported

The health insurance component of Medicaid could pay for implant-supported dentures when medically necessary, regardless of the state where you live. The rules apply uniformly nationwide when treating an illness, injury, disease, disability, or developmental condition.

Medicaid covers dental implants across the country when needed to prevent further bone atrophy caused by diseases (diabetes, digestive disorders, or osteoporosis) or when required to reconstruct a broken jaw.

Two kinds of false teeth fit into this category because they transfer the pressure from biting and chewing directly to the jawbone, stimulating regrowth.

  1. Permanent dentures remain in your mouth but cost more
  2. Snap-on dentures require removal at night for cleaning

Free permanent dentures for seniors on Medicare follow the same protocol. Osteoporosis occurs frequently with the elderly and could form a solid basis to establish medical necessity.

Tooth-Supported

The dental insurance element of Medicaid could pay for tooth-supported dentures that rest on the gums to restore smiles and chewing function. However, two caveats determine the benefits you might receive.

  1. Medicaid dental coverage for adults varies by state, and only thirty-three pay for restorative care (false teeth)
  2. The least expensive treatment alternative rule limits payments to low-end false teeth rather than pricier upgrades

Partials

Medicaid might pay for partial dentures subject to the two qualifications. A partial denture is a plate with one or more false teeth made of plastic or metal with clasps to keep the appliance in your mouth.

The coverage for partial dentures comes down to two issues.

  1. Payments in the states providing benefits for restorative care
  2. Limited to the low-price plastic base and metal clasps (not precision)

The cost of partial dentures with Medicaid rests on where you live and the appliance grade you would like to have fit and fabricated.

Immediate

Determining whether your Medicaid plan will pay for immediate dentures is tricky because you introduce two additional caveats. The dentist fabricates temporary false teeth on the same day as the extraction to avoid a gap in your smile while your gums and jawbone heal.

The coverage for immediate dentures boils down to four questions.

  1. Does your state pay for the extraction of decayed teeth?
  2. Are the temporary replacements for cosmetic purposes only?
  3. Does your state provide benefits for restorative care?
  4. Does the extra cost violate the least expensive treatment rule?

Same-day dentures that accept Medicaid will prove challenging to find because you must meet all four criteria. The Dental Benefits Manager (see below) would be your best starting point.

Medicaid Denture Coverage by State

The state where you live is the primary factor determining whether Medicaid covers tooth-supported dentures in 2022 because the dental insurance component applies with these services.

Medicaid is a federal program, and each state has the latitude in deciding what benefits to support for oral care, what to name its program, and which private companies will administer claims.

Cost with Medicaid

The cost of dentures with Medicaid depends on the restorative care benefits offered by your state when you need tooth-supported appliances (most common).

Each state decides whether to pay for the initial installation, how often they cover replacements as your bone and gums shrink, and whether to impose an annual maximum benefit. As you can see, thirty-three currently pays something for false teeth, while seventeen do not.

Covering DenturesNot Covering Dentures
AlaskaAlabama
ArkansasArizona
CaliforniaGeorgia
ColoradoHawaii
ConnecticutKansas
DelawareMississippi
FloridaMaine
IdahoNew Hampshire
IllinoisNew Mexico
IndianaOklahoma
IowaSouth Carolina
LouisianaTennessee
MarylandTexas
MassachusettsWest Virginia
MichiganVermont
Minnesota 
Missouri 
Montana 
Nebraska 
Nevada 
New Jersey 
New York 
North Carolina 
North Dakota 
Oregon 
Pennsylvania 
Rhode Island 
South Dakota 
Utah 
Virginia 
Washington 
Wisconsin 
Wyoming 

Dental Benefits Managers

Private third-party companies called Dental Benefits Managers (DBM) adjudicate claims for each state and represent the final authority on whether your Medicaid plan pays for the type of tooth-supported dentures recommended by your provider.

Find the DBM name from your member ID card and have the provider submit correspondence and claims information to the organization chosen by your state.

  • Dentaquest
  • Liberty Dental
  • Managed Care of North America (MCNA)
  • Delta Dental

Managed Care Organizations

Another set of companies called Managed Care Organizations (MCO) represents the final authority on whether Medicaid will pay for implant-supported dentures.

An MCO is a private third-party company that administers claims processing for the health insurance component. Submit the letter of medical necessity composed by your physician and dentist to the MCO printed in bold letters on your member ID card.

As you can see, each state can choose multiple MCOs to administer their plans, so it is understandable if you are confused.

  • Aetna Better Health: CA, FL, IL, KS, KY, LA, MD, MI, NJ, NY, OH, PA, TX, WV, VA
  • Amerigroup: NJ
  • Anthem: CA, IN, KY, NV, VA, WI
  • Blue Cross Blue Shield: is a national federation of affiliated companies using this trade name, operating in twenty-four states
  • Caresource: GA, IN, OH
  • Emblemhealth: NY
  • Fidelis: NY
  • Healthfirst: NY
  • Humana: FL, IL, KY
  • Meridian: IL, IA, MI
  • Metroplus: Five boroughs of NCY – Bronx, Brooklyn, Manhattan, Queens, and Staten Island
  • Molina: CA, FL, ID, IL, KY, MI, MS, NM, NY, OH, SC, TX, UT, WA, WI
  • MVP: NY, VT
  • United Healthcare: Offers plans nationwide
  • UPMC Health Plan: MD, OH, PA, WV
  • Sunshine Health: FL
  • Staywell: FL
  • Wellcare: AZ, FL, GA, HI, KY, MO, NE, NJ, NY, SC

Brand Names

Branded names concocted by each state sow confusion for low-income adults wondering whether their Medicaid plan pays for dentures. Do not feel bad if you fall into this trap. You have plenty of company.

Just scroll back to the top if you found this article by searching for any of these brand names that confound many people – especially seniors.

StateBrand 1Brand 2
ArizonaCare 1stAHCCCS
CaliforniaMedi-Cal
ColoradoHealth First Colorado 
ConnecticutHuskyConnecticare
GeorgiaPeach State Health Plans 
HawaiiQuest Integration 
IllinoisMedical CardCounty Care
IndianaHoosier CareHIP Plus
KentuckyPassportKY Health Choices
LouisianaHealthy Lousiana 
MarylandMedical Assistance 
MassachusettsMassHealth 
MichiganMedical AssistanceHealthy Michigan Plan
MinnesotaMedical Assistance 
MissouriMissouri Care 
New JerseyNJ Family Care 
New YorkHealthy Choice 
North CarolinaHealth Choice 
OhioBuckeye Insurance 
OklahomaSoonerCare 
OregonOregon Health Plan 
PennsylvaniaMedical Assistance 
South CarolinaHealthy Connections 
TennesseeTennCare 
TexasSTAR 
VirginiaCover VirginiaFamily Access to Medical Insurance Security
WashingtonApple Health 
WisconsinBadgerCare