Routine dental services are available to Medicaid beneficiaries from birth through the month of their 21st birthday, as well as adults enrolled in the Mental Retardation/Related Disabilities (MR/RD) Waiver program. Dental benefits include any diagnostic, rehabilitative or corrective procedures and supplies and preventive care furnished or administered under the supervision of a dentist. Services include cleanings, X-rays, in-office fluoride treatments (every 6 months), sealants, restorations (fillings), extractions, replacement of missing teeth (dentures and partials for beneficiaries under the age of 21) and oral surgery procedures. Services are subject to change based on funding availability.
Services for beneficiaries over age 21 are limited to emergency treatment only. These services are necessary to repair traumatic injury, to relieve acute severe pain, to control acute infectious processes, and emergency services necessary due to a catastrophic medical condition. This would include diagnostic X-rays, extractions and limited oral surgery services for traumatic injuries, such as fractures. Services are subject to change based on funding availability. Adults over the age 21 who may need assistance with dental health care may visit the South Carolina Dental Association’s website at www.scda.org/clinics.htm to get a listing of Public Assistance Dental Clinics.
Emergency dental services are available to all Medicaid beneficiaries. Oral surgery services are covered as part of emergency dental services. Non-covered procedures are those that do not restore a bodily function, are frequently performed without adequate diagnosis, are not proven effective, or are experimental in nature. The services of an assistant surgeon who actively assists an operating dental surgeon are covered and are limited to certain major surgical processes consistent with good medical practice.
Family members or guardians of special needs beneficiaries can obtain information on the MR/RD Waiver program through the Department of Disabilities and Special Needs website at www.state.sc.us/ddsn/. Another resource for families with special needs children is Family Connection of South Carolina. This non-profit agency connects parents with other parents to offer emotional support and understanding. This organization also assists the families in locating doctors and services for their child. Their website address is www.familyconnectionsc.org.
