J Health Care Poor Underserved. 2025;36(4):1193-1208. doi: 10.1353/hpu.2025.a975582.
ABSTRACT
Dental care remains an optional benefit for adults with Medicaid, with coverage varying across states. Recent expansions increased periodontal service coverage, but the scope of coverage and the policies that govern that scope remain unknown. This study analyzed coverage policies and fees for four periodontal services across 43 Medicaid programs between January and March 2024. Frequency limitations were the most common coverage policies identified, followed by prior authorization requirements, clinical requirements, and quadrant limitations. Veteran Health Administration fees were roughly three times higher than Medicaid fees across the four dental services. Current coverage policies may not consider the multidimensional and nuanced pathogenesis of periodontitis and the need for individualized treatment plans based on patient risk factors and disease progression. Furthermore, low reimbursement rates and administrative challenges may discourage dentists from participating.
PMID:41355638 | DOI:10.1353/hpu.2025.a975582
