Medicaid Covers Kids Under 21 As Part Of EPSDT Benefits
The short answer is “yes.” If you’re on Medicaid in Texas, you can get dental benefits from Medicaid as part of the EPSDT program. That’s short for “Early and Periodic Screening, Diagnostic and Treatment.” Basically, this is a program that ensures that kids on Medicaid can get the care they need to address health problems early, get proper care, and ensure they stay healthy as they grow.
If you have a child in Texas, you can enroll them in one of two covered Medicaid dental plans from Dentaquest and MCNA Dental. These are the only two companies that offer Medicaid dental insurance for kids in the state. Both plans are free of charge if you qualify for Medicaid.
They provide similar coverage for kids, too. As part of your child’s Medicaid dental benefits, they will get coverage for a wide variety of essential dental treatments as they grow. This includes:
- Teeth cleanings
- Necessary x-rays
- Oral exams
- Dental sealants and fluoride treatments
- Dental fillings
- Tooth extractions
- Root canals
- Dental emergency visits
And much more. If you qualify for Medicaid and sign up for a Dentaquest or MCNA Dental plan, your child will have all of the coverage they need for a healthy mouth, all for no out-of-pocket costs. If you need to enroll your child, you can visit the Healthcare.gov website for all the information that you need to get started.
CHIP May Be An Option For Kids Even If You Don’t Qualify For Medicaid
Unfortunately, many families make too much money to qualify for Medicaid, but not quite enough to afford the dental insurance and treatment that their kids need. That’s where CHIP steps in. CHIP is short for Children’s Health Insurance Program.
This is a program that’s similar to Medicaid, and lets you get your child the dental care they need without high insurance prices or co-pays. The cost of CHIP depends on your income. You will pay an enrollment fee every year, which costs a maximum of $50 per family, per year.
One of the main differences between CHIP and Medicaid is that Medicaid has no co-pays or out-of-pocket costs. However, CHIP does. The amount you will pay will vary depending on your income. Families with less income may pay just $3 to $5 per visit to the doctor or dentist, while those with more income may pay between $20 and $35 per visit.
All kids under 18 years old can qualify for CHIP. This is a bit more restrictive than Medicaid, which covers kids up to the age of 20.
You can also enroll your child in CHIP if you’re a pregnant woman and your child has not yet been born. CHIP in Texas is limited to U.S. citizens and legal permanent residents who are also Texas residents.
Unlike Medicaid, which has just two plans for kids in Texas, there are a lot more CHIP plans available from top insurers like UnitedHealthCare, Aetna, and BlueCross and BlueShield of Texas. You can see a full list of plans on the Texas Health and Human Services website here.
Just like Medicaid, CHIP will provide your child with all of the dental services they need to maintain a healthy smile. This includes checkups and cleanings, fillings, extractions, emergency care, and all other medically necessary treatments.
Medicaid Doesn’t Typically Cover Adults, Except For Emergency Treatment
Kids are only covered by Medicaid until they turn 21, and they're only covered by CHIP until they're 18. After this point, they will be considered to be adults, and they will no longer qualify for children’s Medicaid or CHIP coverage.
Generally speaking, adults only qualify for emergency services under Medicaid. This could include something like a tooth extraction to remove a damaged tooth, or splinting a loose or knocked-out tooth. Preventive, periodontal, restorative, and oral surgery services are not provided to healthy adults.
However, if you or your child are physically or developmentally disabled, Medicaid may offer more extensive coverage. Seniors in Texas who are over the age of 65 may also qualify for additional benefits.
Got More Questions About Medicaid And CHIP? Check Out These Resources!
We know that understanding Medicaid and CHIP coverage in Texas can be difficult. We hope our above overview was helpful. But if you’d like to dig a little deeper and learn about coverage, income limits, and other details, we’ve put together some helpful links below. Take a look, and get all the information you need:
- Medicaid & Chip – Texas Health & Human Services
- CHIP – Medicaid.gov
- Medicaid & CHIP in Texas – Medicaid.gov
- Get Coverage – Healthcare.gov
Need A Medicaid Or CHIP Dentist In Buda? Come To Kids Tooth Team!
Dental care is absolutely essential for kids of all ages. A healthy mouth helps protect your child’s overall health, and the oral hygiene habits they develop when they're young will stick with them for the rest of their lives. For that reason, it’s important to start seeing the dentist when they're young, and visit regularly as they grow.
If you’re looking for a Medicare or CHIP dentist in Buda or South Austin, Dr. Alexandra Otto and the staff at Kids Tooth Team are here to help. Dr. Alex is a board-certified pediatric dentist, and treats kids and families from all walks of life in Hays County. To learn more and schedule your appointment, just give us a call at (512) 523-4774, or feel free to schedule an appointment online. We're always accepting new patients in Buda and the surrounding areas, and we’d love to meet your little one!