…it's not.

Don't let anybody fool you — Medicaid dental implants are one of the most confusing topics out there. Many people think coverage simply doesn't exist. But that isn't always true.

Here's the thing…

Does Medicaid cover implants at all depends on nearly 3 factors:

• Where you live

• If you need the procedure for a medical reason

• If you find a dentist that accepts Medicaid payments

Get these three things sorted out and you've got a good chance of having Medicaid cover the bulk of the costs.

Let's dig into…

• What Are Medicaid Dental Implants?

• Does Medicaid Cover Dental Implants?

• Medicaid Dental Implants Eligibility Checklist

• What To Do If the State Doesn't Cover Implants

What Are Medicaid Dental Implants?

Simply put, a dental implant is an artificial tooth root designed to permanently replace missing teeth. Metal implants are placed into the jaw and capped with crowns that look and function just like your natural teeth. They never come out like dentures — they're yours forever.

The issue with implants is they don't come cheap.

According to the ADA, dental implants can cost anywhere from $3,000 to $5,800 per tooth without insurance. That's a costly burden for low-income families to bear.

That's where Medicaid coverage can help…

Medicaid is United States government-funded health insurance for individuals who fall into certain categories such as low-income households, individuals with disabilities, children, pregnant women, and elderly citizens. Currently, 87 million Americans are enrolled in Medicaid. With so many people enrolled in Medicaid plans, understanding what your plan covers should be a top priority.

Does Medicaid Cover Dental Implants?

Let's cut right to the chase…

Maybe.

While there's no federal law requiring Medicaid dental benefits for adults over the age of 21, many states choose to provide some level of service anyway. That means Medicaid coverage for dental services varies drastically by state. Some states offer limited dental benefits to adults — others cover implants specifically. Many fall somewhere in between.

On a more positive note…

As of right now, 49 states along with Washington D.C. offer some form of adult dental benefits through Medicaid. However, keep in mind that dental implants are typically reserved for those that require the procedure for medical necessity rather than cosmetic purposes.

Here's a few examples of states that recently improved Medicaid dental benefits to include implants:

• Kentucky – Kentucky expanded dental coverage to include fillings, crowns, implants, and dentures.

• New York – Due to a 2024 legal settlement, Medicaid beneficiaries in New York will soon be eligible for implant coverage. Approximately 5 million beneficiaries will be affected by this change.

• Kansas – The state of Kansas chose to expand its adult dental benefit package over the course of several years.

Regardless of which state you reside in, there's a good chance Medicaid covers implants — you just might have to meet certain qualifications.

The Medicaid Dental Implants Eligibility Checklist

There's a part of this process that most people rush through…and it always comes back to bite them.

Before you assume Medicaid doesn't cover implants — or that dentists won't take Medicaid payments — follow this quick checklist. Every point below improves your chances of having your procedure covered.

1. Check The State's Adult Dental Coverage First

Alright — this is where we start. Visit your state's Medicaid office website and look for keywords like implants or major restorative procedures. If the state provides "all inclusive dental benefits" for adults you're in a good spot.

2. Get a Medically Necessary Determination

This step cannot be stressed enough…

If a dentist determines that you need a dental implant for medical reasons, you're golden. Medicaid will cover cosmetic procedures very rarely. But when it comes to dental implants being necessary for your overall health — states tend to pay a lot closer attention. Things like…

• Dental problems that were caused by an accident and are needed as part of a reconstructive process.

• Not being able to wear dentures due to unique bone structure or medical conditions.

• Dental issues that are preventing you from maintaining your overall health through proper diet and nutrition.

• You have specific medical conditions that require teeth for functionality.

…it all matters when justifying the need for dental implants. If your dentist signs off that you need implants for medical reasons, make sure you keep that paperwork.

3. Find a Dentist Who Accepts Medicaid

Did you know…

Across the United States, only about ⅓ of dentists accept Medicaid. This is a huge problem for many reasons. But as far as getting dental implants with Medicaid is concerned — run, don't walk to find a dentist in your area that accepts Medicaid.

Searching for a dentist that accepts your insurance should be the first step. Not last.

4. Understand Prior Authorization Requirements

Prior authorization means exactly what it sounds like.

In order for Medicaid to authorize payment for your implant procedure, your dentist must submit a detailed treatment plan along with documentation. Then, Medicaid reviews the information to determine if the procedure will be covered. Thats why starting steps 1-3 with your dentist is crucial. Submitting a claim without prior authorization is sure way to guarantee denial.

Ensure that your dentist's office is experienced in handling the prior authorization process. They should be able to do this for you.

5. Know How To Appeal

Medicaid is a tricky beast.

If your application for dental implants gets denied, appeal. Most states have an established process for appealing Medicaid denials, either by the patient or the dentist on the patient's behalf. As of 2024, the recent Ciaramella v. McDonald settlement in New York State even expanded reasons why you can appeal an implant denial. If you're told "dental implants are not a covered benefit" and your state does cover implants — that's incorrect and you should appeal as soon as possible.

Never accept a denial without asking "why?". There is always a way to fight back.

What To Do If the State Doesn't Cover Implants

This isn't the happiest of topics but hear me out…

Seven states still only offer limited dental coverage or emergency dental care only. If you live in Arizona, Florida, Georgia, Nevada, Texas — your options for Medicaid dental benefits are limited.

Currently…

• Arizona

• Florida

• Georgia

• Nevada

• Texas

offer emergency dental coverage only. But that doesn't mean you're out of luck.

Depending on your state, dental schools and community health centers are always great options. Some states even offer benefits outside of Medicaid.

Research local dental schools in your area and see if that's an option.

Bottom Line on Medicaid Dental Implants

Medicaid dental implants are possible. However, they do require some forethought and understanding on your part.

Remember…

• Visit your state Medicaid office website and make sure implants are covered.

• Obtain documentation from your dentist that you need implants for medical purposes.

• Find a dentist that accepts Medicaid before scheduling an appointment.

• Make sure your dentist has experience with Medicaid prior authorization.

• Don't be afraid to appeal if you believe you were wrongly denied.

States are continuously updating their Medicaid dental benefits every year. With new states expanding their coverage as we speak, don't give up if your state isn't on the list above. Dental implants with Medicaid are possible — you just have to put in the work.