Finding dentists who accept Medicaid for adults over 21 is straightforward.
Search engine queries will only lead you in endless circles.
The Dental Benefits Manager (DBM) selected by your state publishes an online provider directory that creates a list of in-network specialty dentists sorted by proximity to your zip code.
Of course, the DBM list will have entries only if your state supports the specialized service you need. While a federal program, each state decides what dental services it covers.
Medicaid Dentist Provider Directories
Online provider directories are the surefire way to find local dentists accepting Medicaid for adults over 21. You can generate a quick list of providers sorted by distance from your zip code and filtered by specialty.
CMS Directory
The Centers for Medicare & Medicaid Services (CMS) maintains an online directory of dentists accepting at least one Medicaid plan for children. Many of these offices also treat adults – provided your state supports the specialized service for patients older than 21.
Begin with the CMS online dental office finder tool.
- Select your state
- Choose the plan
- Enter your zip code
- Click accepts new patients
Remember that you must confirm that the provider takes patients associated with your Dental Benefits Manager (see below), which might have a slightly different network.
DBM Directories
The online provider directory published by the private company processing dental claims is the ultimate authority on local dentists accepting Medicaid for adults for your specific plan, as each maintains a unique network.
Look at your membership card to identify two possible private companies that your state assigned to administer your plan.
- Managed Care Organizations (MCO) adjudicate health insurance claims
- Dental Benefits Managers (DBM) process oral care claims
If your member card does not list the DBM, visit the MCO website to find this resource.
DentaQuest
Most adults will use the DentaQuest online provider directory to find a neighborhood dentist that takes their specific Medicaid plan. DentaQuest is the nation’s largest DBM, supporting 30 state programs and serving over 25 million recipients.
Begin at the DentaQuest member webpage and follow these steps.
- Click on the link for your state
- Follow the “Find a Dentist” link
- Enter the zip code for your address
- Choose the exact plan for your state
- Search by dentist name, specialty, facility, or type
Liberty
Another large group of adults could use the Liberty provider directory to locate a dentist near them who takes their Medicaid plan. Liberty operates as a DBM, supporting 2.7 million recipients in 10 states.
Start at the Liberty web-based find a dentist tool associated with your residence state. Search by zip code, distance, and specialty, or use advanced parameters such as license or NPI number.
MCNA
A minority of adults will use the Managed Care of North America (MCNA) provider directory to find a neighborhood dentist that takes their Medicaid plan. As a DMB company, MCNA supports programs in 8 states.
Begin at the MCNA online find-a-dentist tool. Input your city and state into the search widget and select the plan indicated on your member ID card to ensure accurate results.
Delta Dental
Patients living in New York State might use the Delta Dental DBM provider directory to find a local dentist who takes their specific Medicaid plan. Delta Dental manages oral care benefits for several adult programs.
Utilize the Delta Dental find-a-dentist online search tool to develop your list. Verify the network connected to your plan to get the most accurate listing.
Medicaid Emergency Dentists
Your ability to find local emergency dentists that take Medicaid for adults over 21 depends on the types of oral care benefits supported by your state and any extra parameters you add to narrow the field in your DBM’s provider directory.
Emergency Extractions
Adults looking for emergency tooth extractions that take their specific Medicaid plan should break down the coverage rules into two components: health and dental insurance.
Health Insurance
Medicaid’s health insurance component covers emergency dental work nationwide. If your plan honors a narrow set of claims, you might find a dentist willing to take you as a patient.
Health insurance covers medically necessary dental care arising from non-biting accidents, certain diseases, and treatments considered integral to other services included in the plan.
- Procedures necessary to control bleeding, relieve pain, or eliminate acute infections
- Services that are required to prevent “pulpal death” and the imminent loss of teeth
- Extractions of broken teeth resulting from a covered accident (non-biting)
Dental Insurance
Medicaid’s dental insurance component covers emergency oral care differently in each state. If your plan honors a broader set of claims, you might find a dentist willing to take you as a patient.
Medicaid covers emergency oral care that is not medically necessary in forty-four states. In these instances, tooth extractions might qualify for additional reasons.
- Severe decay (caries)
- Advanced periodontal disease
- Broken teeth from biting accidents
24-Hour Emergency
Finding a 24-hour emergency dentist that accepts Medicaid for adults requires additional research. Begin at the DBM online directory to generate a list of in-network providers near your zip code.
Next, perform an internet search using the provider name to surface their Bing or Google My Business pages. There, you should find a listing showing their office hours.
Open Saturday Emergency
Identifying an emergency dentist who takes Medicaid for adults who are open on Saturday follows the same protocol. Begin at the DBM online directory to generate a list of in-network providers near your zip code.
Next, perform an internet search using the provider name to surface their Bing or Google My Business page. You should find a listing showing the days their office is open there.
Walk In Emergency
Finding an emergency dentist who takes Medicaid for adults and is available for walk-in patients requires a different approach. Use the DBM provider directory to develop your list, then pick up the phone.
An office might accept walk-in recipients, but that does not mean they have dentists waiting on standby. Their schedule might already be full.
When you are in pain, you need treatment right away. Therefore, call the offices on your list today to verify their walk-in openings.
Medicaid for Dentures
Adults over 21 seeking nearby dentists accepting Medicaid for dentures have several factors to consider. Not only do the choices made by your state dictate your success, but the type and cost of the false teeth matter also.
Medicaid covers false teeth in thirty-three states, meaning adults living in the other seventeen are out of luck and will not find a provider taking recipients unless they can afford to pay out-of-pocket.
Same-Day Dentures
Adults are unlikely to find same-day dentures accepting Medicaid due to the least expensive treatment rule. Same-day or immediate false teeth represent premium services that cost more than the alternative: waiting weeks for a lab to fabricate the appliance.
The least expensive alternative treatment clause built into this publicly-funded insurance program means that your dental benefits manager will probably deny claims for same-day dentures because a cheaper option exists.
Snap-In Dentures
Adults are also unlikely to find Snap-in dentures that take Medicaid because the insurance company will deem them cosmetic. Snap-on dentures fit over dental implants, another treatment option that is more expensive than other alternatives.
Medicaid does not cover tooth implants except in NY unless medically necessary. Therefore, the Snap-in dentures would have to meet a strict standard.
- The treatment addresses an underlying health problem, such as osteoporosis affecting the upper or lower jaw.
- The medical issue arose as a side effect of another covered service, such as prescription drugs causing dry mouth.
Medicaid Dental Offices
Your ability to find dental offices near your neighborhood that accept Medicaid for adult patients over 21 depends on their specialty and the oral care benefits supported by your state.
Endodontist
Consult your DBM’s provider directory to find nearby endodontist offices that accept your specific Medicaid plan, provided your state supports this benefit for adults. An endodontist is a dentist specializing in diagnosing and treating tooth pain and performing root canal treatment.
Medicaid covers root canals and other endodontic treatment in twenty-five states, or about half of the country. A root canal eliminates dangerous bacteria by removing tooth pulp, cleaning and disinfecting the remaining dentin, and sealing the tooth.
Periodontist
Adult patients should utilize their DBM’s provider directory to get a list of local periodontist offices that take their Medicaid plan, assuming their state supports benefits for gum surgery. A periodontist is a dentist specializing in preventing, diagnosing, and treating gum disease.
Medicaid covers periodontal treatment in twenty-six states or more than half the country. Recipients above 21 living in these states might find a provider willing to provide these services.
- Deep cleaning (root planing and scaling)
- Gingival flap surgery to treat late-stage disease
- Gum grafting to address receding gum lines
Prosthodontist
Consult your DBM’s online directory to find neighborhood prosthodontist offices accepting your specific Medicaid plan, understanding that your state may or may not support this benefit. A prosthodontist is a dentist specializing in restoring missing tooth and jaw structures.
A prosthodontist can restore missing teeth and jaw structures using dentures or dental implants. Your treatment choice has a profound impact on coverage.
- Medicaid covers dentures for adults in thirty-three states
- Medicaid covers implants only when medically necessary
Other Specialties
Adult recipients should turn to their DBM provider directory to find area dental offices specializing in other areas, such as orthodontia and oral surgery. However, these two specialties are more complex and warrant a more in-depth analysis.
Orthodontists accepting Medicaid for adults must establish a medically necessary reason before the plan will honor claims, as the dental coverage ceases after age 21.
- Temporomandibular Joint Disorders (TMJ or TMD) requiring bite adjustments
- Sleep apnea occurs when crooked teeth restrict or block airflow
Oral surgeons accepting Medicaid for adults have two sets of criteria corresponding to its dual nature as health insurance nationwide and dental coverage varying by state.
- Bone-impacted wisdom teeth extractions are medically necessary and covered by the health insurance element nationwide.
- Gum-impacted wisdom teeth extractions are not medically necessary and are supported by the dental insurance component in thirty-one states.
