Medicaid Dental Insurance in Virginia

Medicaid dental insurance in Virginia is available to qualifying applicants who meet income, age and covered group restrictions. However, comprehensive Virginia Medicaid dental insurance is not available to all qualifying beneficiaries. Instead, comprehensive Medicaid dental coverage is only available to low-income children who are 21 years of age and younger and qualifying pregnant women. While Medicaid dental benefits are available to older beneficiaries as well, these services are limited to medically necessary procedures. To enroll in VA Medicaid dental insurance, claimants must apply for benefits through Smiles for Children, a program under the Commonwealth of Virginia. Anyone who is eligible for dental insurance in Virginia obtains their benefits through the Smiles for Children program, even if claimants are 21 years of age or older. To learn more about Medicaid dental insurance eligibility requirements and the enrollment procedures, applicants can download our comprehensive guide here. To learn more about Medicaid dental coverage plans and get information who is eligible to receive services, potential enrollees review the information below.

What is Medicaid dental insurance in Virginia?

Virginia Medicaid dental insurance is available to qualifying residents through Smiles for Children, the state’s dental program for children who meet eligibility conditions for Medicaid, Family Access to Medical Insurance Security (FAMIS) and FAMIS Plus. To receive full dental Medicaid coverage, residents must be 21 years of age or younger. However, limited Medicaid dental Coverage is also available to adults 21 years of age or older. If residents are eligible for Medicaid dental insurance in VA, they receive these benefits free of charge. As such, claimants who meet Medicaid dental insurance eligibility requirements receive full benefits such as the following:

  • Twice-yearly cleanings and fluoride treatments
  • Twice-yearly dental checkups (from six months until 18 years of age)
  • Sealants, crowns, extractions and root canal treatments
  • Space maintainers or braces, if necessary
  • Anesthesia
  • Necessary X-rays
  • Oral hygiene education

If Virginia Medicaid dental insurance cannot cover a specific type of service, the dentist will notify the family before treating the patient.

While full Medicaid dental benefits are only available to children, qualifying adults 21 years of age or older receive coverage for medically necessary oral procedures or associated diagnostic services. Limited Medicaid dental assistance may also include biopsies or the removal of tumors, tooth extractions or the repair of traumatic wounds. However, adult patients must first obtain prior authorization from a medical doctor. Additionally, eligible pregnant women receive dental Medicaid coverage throughout the length of their pregnancy. Applicants should learn more about medical and dental Medicaid eligibility requirements in VA before signing up for health programs to make sure the program will meet the needs of the household.

Virginia Medicaid Dental Insurance Eligibility Requirements

To be eligible for Medicaid dental insurance in Virginia, claimants must qualify for medical benefits under the Department of Medical Assistance Services (DMAS). Residents may obtain Medicaid dental Coverage if they meet all age, income, resource and covered group requirements during the Medicaid application process. For instance, claimants may enroll in Medicaid dental insurance under the Families & Children (F&C) covered group if their income falls below the Federal Poverty Level (FPL) and they meet age restrictions. For instance, Medicaid dental insurance in Virginia is available to qualifying pregnant women, children, medically needy claimants, former foster care children and parents or relative caretakers. Furthermore, Medicaid dental insurance is available to low-income claimants under the Aged, Blind & Disabled (ABD) covered group as well. To obtain Medicaid dental benefits under the ABD group, petitioners must be at least 65 years of age or older, be medically needy, blind or disabled, or receive hospice care. However, full dental coverage is only available to children 21 years of age or younger and eligible pregnant women.

How to Enroll in VA Medicaid Dental Insurance

To enroll in Medicaid dental insurance in Virginia, qualifying enrollees must apply for benefits through the state’s medical assistance program. Residents automatically receive Medicaid dental coverage if they complete the application process for Medicaid, FAMIS Plus or FAMIS and receive approval from the state deems for medical assistance eligibility. To obtain Medicaid dental insurance in Virginia, however, petitioners do not need to complete a separate application for benefits. Instead, residents who need Medicaid dental insurance may complete an Application for Health Coverage & Help Paying Costs and submit the completed form to their local Department of Social Services (DSS) office in person or by mail. Alternately, claimants may apply for Medicaid dental insurance benefits and medical coverage online or by telephone. After completing an Application for Health Coverage & Help Paying Costs, eligible claimants will receive medical and dental benefits. To receive coverage under Virginia Medicaid dental insurance, however, patients must visit a participating provider under the Smiles for Children network.

Additionally, residents who meet Virginia Medicaid dental insurance Eligibility Requirements do not receive a separate membership card. Instead, residents who receive Medicaid dental benefits may use a Commonwealth of Virginia plastic identification card or a Managed Care Organization (MCO) membership card. To learn more about enrolling in VA Medicaid dental insurance as well as the many benefits of doing so, download our comprehensive guide here.