Yes. According to the New York State Department of Health Dental Policy and Procedure Code Manual, the Medicaid program covers the cost of full or partial dentures required to alleviate a member’s serious medical issue or one that affects their employability.
Understanding Medicaid Coverage
Medicaid is a healthcare program for pregnant women, children, low-income people, disabled individuals, and older adults. You are eligible for coverage through the program until you turn 65.
Every state administers a Medicaid program and determines member eligibility and coverage guidelines based on federal regulations.
The federal government requires each state to cover various medical services, including:
- Hospital stays
- Nursing home care
- Doctor visits
- Home health care
Dental coverage is optional in every state. In New York, the Medicaid program covers the cost of numerous dental procedures, including dentures and implants.
Requirements to Qualify for Medicaid
New York residents are eligible for Medicaid if they have income and resources below the state limits. In 2023, someone who earns under $1,677 monthly and has resources under $30,180 can qualify for Medicaid coverage. The requirements for couples include a monthly income under $2,268 and resources less than $40,820.
You’re automatically eligible for Medicaid if you qualify for the State Supplement Program. That is a portion of Supplemental Security Income payments in the state.
How to Apply for Medicaid Coverage
If you’re not already a member of the Medicaid program, you can apply by completing an application that outlines your income and other relevant information. You must file your application with the Department of Social Services in the county where you reside.
New York City residents must file with the New York City Human Resources Administration. If you’re over 65, you must include a Supplement A form to outline your resources.
The income and resources you must report when you file your application include:
- Earned income – Your earned income is income from regular employment, operating a small business, freelance work, or renting space in your residence to boarders and lodgers.
- Unearned income – Unearned income includes interest, pensions, insurance payouts, dividends, government benefits, and other payments unrelated to your job.
- Resources – Resources refer to cash, assets, and real property you can convert into cash quickly, including life insurance policies, mutual fund shares, bank accounts, stocks, promissory notes, and bonds.
Dental Care Medicaid Coverage in New York
Medicaid covers full and partial dentures if they are necessary to alleviate your serious health problem or one that interferes with your ability to seek or maintain employment. You must obtain prior approval to receive coverage for dentures through Medicaid.
You can’t replace complete or partial dentures, whether stolen, unserviceable, broken, or lost, within eight years of the initial service. However, coverage will apply if the Department or its agent determines the service is medically necessary.
When you make a prior approval request before eight years have passed, the request must include a physician and dentist letter explaining the circumstances that make the denture replacement necessary. The letter must also explain the denture’s role in improving employability and alleviating the patient’s serious medical condition. The documentation must explain the preventative measures implemented to reduce the necessity for additional replacements.
Medicaid also covers the cost of dental implants if they are medically necessary. You must receive a prior approval request and acquire supporting documentation from your dentist and physician.
A physician’s letter must accompany the request outlining how the implants will relieve your health issue. Your dentist must also provide a letter explaining why alternative treatments won’t correct your dental problem and why you require the implants.
New York residents can receive other medically necessary dental procedures through their Medicaid program without prior approval, such as:
- Preventative care, including cleanings and polishing
- Emergency care, such as treating infections or pain
- Extracting a nonrestorable or infected tooth that doesn’t require a prosthetic
- Periapical, occlusal, bitewing, and extraoral X-rays
- Root canal for one cuspid or incisor tooth
- Oral exams and treatment plans
- Repairs and fillings with plastic materials, silicate cement, silver, or stainless steel
Make an Appointment to Get Fitted for Your Dentures Today
Restorative dentistry is often necessary to restore a patient’s smile and boost their confidence. At Babylon Dental Care, we understand the frustration of talking or chewing with damaged or missing teeth. It can create multiple issues, including the risk of infection, a less youthful appearance, and a variety of dental problems.
Let us give you the smile you always wanted. Call the Babylon dental professionals of Babylon Dental Care at (631) 983-6665 for an appointment in West Babylon to discuss how we can meet your denture needs.