Does ND Medicaid Expansion Cover Dental?
Understand North Dakota Medicaid Expansion dental benefits for adults and children, including coverage details and how to access care.
North Dakota’s Medicaid Expansion program aims to broaden healthcare access for eligible adults. This initiative covers various services such as check-ups, preventive care, and hospital visits. Understanding the specific benefits available through this expansion, particularly regarding dental care, is important for North Dakota residents seeking coverage.
Understanding North Dakota Medicaid Expansion Dental Coverage for Adults
North Dakota Medicaid Expansion does not include comprehensive dental care for adults aged 21 and older. Routine dental and vision care are excluded for this group. This often leads to delayed preventative care and more costly treatments for severe oral health issues.
There are limited exceptions. Routine dental care may be covered for members aged 19 and 20 enrolled through Medicaid Expansion. For adults aged 21 and older, dental coverage is limited, primarily extending to damage to natural teeth from cancer, injury, or accident, not caused by biting or chewing. Dental anesthesia and hospitalization for dental care may also be covered, but require precertification.
While other adult Medicaid categories in North Dakota may have broader dental benefits, including diagnostic and basic restorative services, these are often not available to those covered under the Medicaid Expansion pathway. Dental implants are generally not covered, though implant-supported removable dentures or partial dentures might be considered with prior authorization if existing implants support a medical necessity.
Accessing Dental Care Through Medicaid
Accessing dental care through North Dakota Medicaid begins with identifying participating providers. Individuals can search for dental providers who accept Medicaid through online directories or by contacting the state’s Medicaid agency customer service. The North Dakota Department of Health and Human Services website provides a “Find a Healthcare Provider” tool to assist in this search.
When scheduling a dental appointment, confirm that the dental office accepts North Dakota Medicaid to avoid unexpected costs. Patients should provide their Medicaid ID card and personal identification at their appointment. There are no premiums or copayments for Medicaid services in North Dakota, including those received under the expansion program.
While providers are enrolled in the North Dakota Medicaid Program, their acceptance of new patients can vary, so direct confirmation with the dental office is essential. If difficulties arise in locating a provider, the North Dakota Medicaid customer service line can offer additional assistance.
Dental Coverage for Children under North Dakota Medicaid
Children enrolled in North Dakota Medicaid receive comprehensive dental benefits through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. This program covers services deemed medically necessary to correct or ameliorate health conditions, ensuring access to a full range of preventive and treatment services for individuals under 21.
Dental services covered for children are extensive and include regular check-ups, cleanings, and X-rays, twice per calendar year. Preventative measures like fluoride varnish applications are also covered, up to three times annually. Beyond preventive care, children’s benefits encompass restorative services such as fillings, sealants, and root canals, as well as oral surgery, including extractions.
Medically necessary orthodontics, such as braces, are also covered. Parents or guardians can find pediatric dentists who accept Medicaid by utilizing resources like the InsureKidsNow website or by contacting the state’s Medicaid program for provider lists.