Does Virginia Medicaid Cover Dental Services?
Understand Virginia Medicaid dental coverage. Learn what services are included for residents and how to access care.
Virginia Medicaid offers comprehensive dental coverage for its eligible members, a benefit designed to support overall health and well-being. The scope of these dental benefits can vary depending on the individual’s age and the specific Virginia Medicaid program they are enrolled in. This coverage aims to ensure access to necessary oral healthcare services for many residents across the state.
Eligibility for Dental Benefits
Dental coverage is generally available to most individuals enrolled in Virginia Medicaid programs. The Cardinal Care Smiles program, managed by DentaQuest, specifically provides dental benefits for eligible residents. This includes members aged 20 years and younger, Medicaid members over 21, and pregnant adults enrolled in Medicaid and FAMIS MOMS. Once enrolled in a Medicaid plan, individuals qualify for dental benefits.
The comprehensive dental benefit for all adults enrolled in Medicaid began on July 1, 2021. Individuals can access these benefits if they are part of programs like Commonwealth Coordinated Care Plus (CCC+), which serves those aged 65+, blind, and/or disabled, or Medallion 4.0, which covers children, pregnant women, and other adults.
Covered Dental Services for Adults
Adult Virginia Medicaid recipients (age 21 and older) have access to a range of dental services under the Cardinal Care Smiles program. Specific covered procedures include routine oral exams, cleanings, and X-rays.
Beyond preventive care, adult coverage extends to treatments such as fillings, root canals, and gum-related treatments. Extractions and other oral surgeries are also covered. Dentures are another included benefit, providing options for tooth replacement. Orthodontics (braces) are not a covered benefit for adult Medicaid members.
Covered Dental Services for Children
Virginia Medicaid’s Cardinal Care Smiles program provides comprehensive dental services for children and adolescents through age 20. This extensive coverage includes preventive, diagnostic, and restorative services to support developing oral health. Children can receive regular oral exams, typically every six months, along with cleanings and necessary X-rays. Fluoride treatments and sealants are also covered, focusing on cavity prevention.
Treatment services for children include fillings, crowns, and space maintainers. If needed, root canals and extractions are also covered procedures. Orthodontics, or braces, may be covered for children if they are deemed medically necessary, requiring prior approval. All medically necessary dental services are covered for Cardinal Care Smiles members under age 21, provided by a participating dentist.
Accessing Covered Dental Care
Accessing covered dental care through Virginia Medicaid involves a straightforward process. Recipients can find a participating dentist by utilizing the DentaQuest website’s search tool. DentaQuest manages the Cardinal Care Smiles program, which is Virginia’s dental program for Medicaid and FAMIS. Alternatively, individuals can call DentaQuest directly at 1-888-912-3456 for assistance in locating a provider.
Upon scheduling an appointment, it is advisable for members to confirm that their chosen provider accepts Medicaid. On the day of the appointment, individuals should bring their Virginia Medicaid card and, if enrolled in a managed care organization (MCO), their MCO identification card. There are typically no co-payments for dental care services within the Smiles For Children program. Virginia Medicaid also offers transportation services for dental appointments for eligible members.