Does Virginia Medicaid Cover Dentures?
Navigate Virginia Medicaid for denture coverage. Understand eligibility, benefits, and how to get the dental support you need.
Virginia Medicaid serves as a healthcare program designed to provide comprehensive medical coverage for eligible residents across the Commonwealth. This program ensures access to a range of health services, including dental benefits.
Virginia Medicaid Denture Coverage
Virginia Medicaid, through its CardinalCare Smiles program, covers dentures for adults. This benefit began on July 1, 2021. Coverage includes diagnostic X-rays, examinations, cleanings, fillings, root canals, and gum-related treatments.
Dentures, including both complete and partial prosthetics, are covered when deemed medically necessary. This means the absence of dentures would affect an individual’s overall health or their ability to perform daily functions like eating. While many services are covered, certain procedures like braces and bridges are generally not included for adult Medicaid members.
DentaQuest manages the CardinalCare Smiles program. For some services, including certain dental procedures that support denture placement, prior authorization may be required. Dentists must provide documentation to support the medical necessity for services like dentures to ensure coverage.
Eligibility for Virginia Medicaid
To qualify for Virginia Medicaid, individuals must meet specific criteria related to residency, citizenship, and income. Applicants generally need to be residents of Virginia and U.S. citizens or lawful permanent residents. Income limits are a primary factor, typically tied to Federal Poverty Level (FPL) guidelines, though the exact thresholds can vary based on household size and program type.
Medicaid offers coverage to various groups, including children, pregnant individuals, adults under age 65, and those who are aged, blind, or have disabilities. For adults under 65, income must not exceed a certain percentage of the FPL, which can change annually. Pregnant individuals and children have different income thresholds for eligibility, often allowing for higher income levels.
Applying for Virginia Medicaid Benefits
The application process for Virginia Medicaid offers several convenient methods to submit information. Individuals can apply online through the CommonHelp website. Additionally, applications can be submitted over the phone by contacting the Cover Virginia Call Center.
For those who prefer traditional methods, paper applications are available and can be mailed or dropped off at a local Department of Social Services (DSS) office. When applying, individuals will need to provide specific documents to verify their eligibility. These commonly include proof of identity, such as a U.S. ID or birth certificate, and proof of Virginia residency, like utility bills or a lease agreement. Applicants must also supply income information, such as recent pay stubs or W-2 forms, and Social Security Numbers for all household members.
Accessing Denture Services with Virginia Medicaid
Once approved for Virginia Medicaid, individuals can begin the process of accessing denture services through the CardinalCare Smiles program. The first step involves finding a dental provider who accepts Virginia Medicaid. DentaQuest, the administrator for CardinalCare Smiles, offers an online search tool and a dedicated phone line to help members locate participating dentists in their area.
It is advisable to contact the dental office directly to confirm they accept Medicaid coverage before scheduling an appointment. While a referral is generally not needed to see an in-network dentist, some specific dental services may require prior authorization from DentaQuest. The dentist will typically submit the necessary documentation to DentaQuest to demonstrate the medical necessity of the dentures or other procedures. Following approval, the dentist can proceed with the required treatments and the fitting of dentures.