Medicaid Member Dental Benefits

New York State Medicaid offers an extensive dental plan for Medicaid members, through the New York State Fee-for-Service program or through a Medicaid Managed Care plan. It is important to see your dentist on a regular basis to maintain a healthy mouth and prevent future problems.

Medicaid Dental Services

Covered dental services include essential services such as medically necessary:

  • Oral Exams,
  • Cleanings,
  • X-rays,
  • Restorations,
  • Dentures,
  • Extractions,
  • Crowns,
  • Root Canals, and
  • Implants in certain circumstances.

Your Medicaid-enrolled dental provider will make treatment recommendations based on your individual dental needs and submit prior approval requests when necessary.

New York State Medicaid also covers dental visits through teledentistry, where appropriate. This can be helpful for members who live in rural communities and do not have access to an in-person dentist. Speak to your dental provider to see if they offer teledental services.

Except for appropriate copays, no additional charge may be made by a provider to a Medicaid member unless you agree to and sign a private pay agreement mutually agreed upon at the start of dental treatment.

Importance of Oral Health

Good oral health starts early including during pregnancy, and is very important to your overall health and well-being. Tooth decay (cavities or caries) is the most common chronic disease of childhood in the United States. Good oral health starts when the child is an infant. Children should see their dentist within the first 6 months of tooth eruption or by their first birthday. Fluoride varnish can help to prevent tooth decay and can be applied to your child's teeth by the dentist or by the child's primary care physician as early as 6 months or the first tooth eruption.

It is also very important for adults and seniors to maintain good daily oral hygiene and visit their dentist regularly to prevent cavities and tooth loss (periodontal disease). It is important to see a dentist even if you do not have your own teeth, as an exam of the mouth can provide early detection of pre-cancerous or cancerous lesions. Oral health can have an impact on chronic medical conditions such as diabetes, heart disease or stroke, or those conditions which cause weakened immune systems such as HIV or organ transplants.

New Dental Benefit Highlights - 2023

  • As of July 1, 2023 New York State Medicaid covers certain sedation services for children through the age of 20, as well as for Intellectual and Developmentally Disabled (IDD) members/enrollees, when medically necessary to safely render dental treatment.
  • Medicaid-enrolled dental providers will be incentivized with enhanced payments for IDD members who require medically necessary dental treatment in the hospital setting.
  • Enrolled Medicaid dentists will be incentivized for providing dental services to IDD members in the private practice setting.

How to Locate a Dental Provider

Medicaid members can access the following resources to locate a New York State Medicaid-enrolled dental provider:

Members who are enrolled in a Medicaid Managed Care plan should contact their plan for assistance in locating a participating dental provider.