Arkansas Medicaid, managed by the Division of Medical Services (DMS) within the Department of Human Services (DHS), provides coverage for dental services. The scope of this benefit, however, varies significantly based on the age of the recipient. Children under the age of 21 receive a much broader range of care compared to adults, whose benefits are generally more limited.
Eligibility Criteria for Arkansas Medicaid
To enroll in Arkansas Medicaid, an applicant must be a resident of the state and a U.S. citizen or qualified non-citizen. Eligibility is determined based on income and household size, measured against the Federal Poverty Level (FPL). Income limits are specific to the coverage group, with different pathways for children, pregnant individuals, and adults.
Children and pregnant women generally qualify with higher incomes than non-disabled adults. For example, children under 18 may be eligible for coverage with family incomes up to 211% of the FPL through the ARKids First program. Non-elderly adults aged 19 to 64 can qualify through the ARHOME Medicaid expansion program if their household income is at or below 138% of the FPL.
Other qualifying categories include the Aged, Blind, and Disabled population, who must meet both income and asset limits. Applicants can apply online through the Access Arkansas portal or in person at a local Department of Human Services office.
Dental Services for Adults
Dental coverage for Arkansas Medicaid beneficiaries aged 21 and older is relatively limited and focuses primarily on maintaining basic oral health and addressing acute issues. The state’s adult dental benefit has an annual dollar cap to manage costs. Covered services are subject to an annual limit of $500 per beneficiary, not including the cost of extractions.
Services typically covered within this cap include routine preventative care, such as annual cleanings and necessary X-rays. Treatment for pain and infection, which may require tooth extractions, is generally covered outside of the annual dollar limit. Furthermore, beneficiaries may be eligible for a single set of dentures or partial dentures over their lifetime.
Cosmetic procedures, extensive orthodontics, and more complex prosthodontic services are generally not covered under the adult dental benefit. Coverage is restricted to what is considered medically necessary to relieve pain, treat infection, or prevent a more severe medical condition. The state recently transitioned the administration of the adult dental program back to a fee-for-service model, managed directly by DMS, effective November 1, 2024.
Comprehensive Dental Care for Children
Children under the age of 21 who are enrolled in Arkansas Medicaid or ARKids First receive comprehensive dental coverage that extends far beyond the adult benefit. This robust coverage is mandated by federal requirements for pediatric Medicaid benefits. The program aims to ensure that children receive all necessary dental services to achieve and maintain good oral health.
Preventative services are a major focus, including regular oral evaluations, cleanings, fluoride treatments, and dental sealants to protect the chewing surfaces of molars. Restorative treatments are also fully covered, encompassing fillings, root canals, and crowns to repair damaged teeth. There is no annual dollar limit on medically necessary dental services for children, ensuring full access to care.
Medically necessary orthodontics, such as braces, are covered when required to correct a severe malocclusion that impacts a child’s health or ability to function. The state requires prior approval for all orthodontic treatments to confirm medical necessity.
Finding an Arkansas Medicaid Dental Provider
Recipients seeking dental care must locate a provider who accepts Arkansas Medicaid. The Arkansas Department of Human Services maintains an online tool for beneficiaries to search for enrolled providers in their area. Users can filter the search to specifically find dentists and dental specialists.
For personalized assistance with locating a provider, beneficiaries can contact the ConnectCare help line. This resource is available to help individuals find a Medicaid dentist and navigate the health care system. Since the state’s transition from managed care, almost all previously participating dentists are enrolled as fee-for-service providers.
Beneficiaries should confirm acceptance of Arkansas Medicaid coverage when scheduling an appointment, even if a provider is listed in the directory. The ConnectCare help line can also answer questions regarding specific covered services or the status of a claim.