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My grandfather has a missing front tooth, and would like to have that fixed. I'm wondering if these type of dental services provide cosmetic dental services for a missing tooth, and if the payment will come from Medicaid.
Medicaid will not cover cosmetic dental work. Even private non-Medicaid dental insurance (like Delta Dental) doesn't cover cosmetic work 100%, if at all. And it's pretty expensive.
My MIL is in LTC on Medicaid, and has mild/moderate dementia. She had a broken front tooth and the visiting dental service would only file it down a little so that it wasn't so sharp on her tongue. Because the very elderly can have many other health and medical issues, the dentists are very conservative about what type and how much work they do on the patients. If your Grandfather has a cavity, and he was cooperative and physically able to lay back and be still in a chair, they would drill and fill it. They would pull teeth if it was medically necessary. But they won't put on caps or crowns in my experience. Medicaid differs by state so it may be slightly different where he lives.
Cosmetic work is almost always private pay. The exceptions tend to be if it was cancer or trauma related. Like rebuilding a breast after cancer surgery or rebuilding a jawline & teeth after auto accident,
Medicaid programs are uniquely run by each State but under overall federal guidelines. Most States Medicaid limit dental to preventative services for kids or for care needed from a trauma. If your dads NH actually has a dentist that comes regularly to the facility (this is amazing if happening as it’s really hard to work on patients with dementia which lost in a NH have), ask them to evaluate him. Your dad gets a monthly personal needs allowance if he is on LTC Medicaid; tends to run $50-60 for most states. He can use this $ to pay for the consultation with the dentist.
I just want to add that you will need to "pick your battles" with your Grandfather's health/medical needs. If he has any memory or cognitive decline, anything (like a partial or dentures) that he has to take care of or can remove on his own will get lost or accidentally thrown away. This happens all the time in facilities and they aren't responsible for this loss. My 100-yr old Aunt with advanced dementia has barely any teeth and we had to stop putting in her partials but she can still eat a healthy and varied diet with what she has left. She just looks like a jack-o-lantern when she grins. This is why I've vowed to get implants if I can.
Contact Medicaid to find out if it is covered (just say which tooth is missing, not that it's "cosmetic"). Sadly, dental work is not always treated as a health issue, which it should be, in my opinion.
I don't have experience with dental care and if Medicaid will cover but the nursing home that my mother is in has a dental service that they use. You may want to ask the business office whether they utilize a dental service and then maybe that dental service could answer your question about Medicaid coverage for cosmetic dental services.
In most US states, Medicaid will not pay to replace a missing tooth. The services the mobile dental company are very limited (fillings, extractions, etc). Depending on your grandfather’s medical health, one option that might be possible, is to have the dentist take an impression of the area of the missing tooth and surrounding teeth then a dental lab could make what is called a “flipper” partial denture. This appliance would need to be removed eating and sleeping. The removable flipper would have one false tooth on it and would fit into the mouth somewhat like a retainer. It is held in place with tension against the other teeth. Downside is that a flipper partial could easily be lost or misplaced in a nursing home. The cost would be completely a “private pay” situation, with no insurance or Medicaid assistance. It’s been several years since I worked in the dental field, but rough guess at to cost is probably $500-$900 dollars (USD).
When Mom was on Medicaid, I was asked by the Nurse when he last exam was so they could have her checked at the 6 month mark. A dentist did come into the facility. I do remember my cousin telling me that he got a call from the NH in ref to my Aunt. At 80+ years, with advanced ALZ and on Medicaid, they wanted to get permission to cap some of my Aunts teeth. My cousin said no. I live in NJ.
I don't think Medicaid would allow a tooth replacement. Lots of work goes into getting one put in. The partial? The one that was suggested to my husband was grounding down the two teeth on each side of the missing tooth. Then making a mold that would slip over the two teeth with the new one between them. I think it would be permanent like 2 crowns. Problem, now susceptible to needed root canals in the future.
Likely no help from Medicaid for dental work, which is expensive. Speaking about dental work and costs, I don't know what the cost is for a front tooth, but it costs more for a molar. For example on Aug. 14th, my molar with a large filling showed decay under the filling where floss wouldn't reach. Kaiser's Delta Dental copayment for a root canal and sealer cost me $600, and the new crown, $533, just for one tooth, and it's taken me so much time for each job since my dentist sent me to an endodontist for consultation on Aug. 24th, then root canal on Aug. 31st. Two weeks afterwards, back to my dentist to get a temporary filling, two weeks after that on Sep. 13th, the temporary crown. Dentist is so busy I must wait until Wed., Oct. 5th to get the permanent crown, unless a patient's cancellation gets me in earlier. Without Medicare Advantage Plus, it's impossible to get expensive dental work for one tooth, let alone more teeth. I cannot chew anything on affected side and eat mostly soft foods until all dental work is completed. A person with dementia cannot follow explicit care instructions for teeth or anything else, expensive or not.
Actually, dental care coverage is largely what your individual State program has or does not have. Here is a cheat sheet by state, but this is from a year ago. Our state had no coverage, but the State General Assembly approved legislation signed by our Governor to start having some dental care as of 1/1/2023. All to say, check with your State Medicaid office .....
The US Gov ONLY required Medicaid-covered dental care for those 21 and younger! Each state, "Individuals Age 21 and older: States may elect to provide dental services to their adult Medicaid-eligible population or, elect not to provide dental services at all, as part of its Medicaid program. While most states provide at least emergency dental services for adults, less than half of the states provide comprehensive dental care. There are no minimum requirements for adult dental coverage.
Sigh123: A missing tooth most likely requires a specialist and not just a general dentist. It will require a dental implant or a bridge. Not all dentists prepare dental implants and dental bridges. So even if Medicaid does perchance cover the missing tooth, the required work is not considered 'regular' dentistry.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
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APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
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This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
My MIL is in LTC on Medicaid, and has mild/moderate dementia. She had a broken front tooth and the visiting dental service would only file it down a little so that it wasn't so sharp on her tongue. Because the very elderly can have many other health and medical issues, the dentists are very conservative about what type and how much work they do on the patients. If your Grandfather has a cavity, and he was cooperative and physically able to lay back and be still in a chair, they would drill and fill it. They would pull teeth if it was medically necessary. But they won't put on caps or crowns in my experience. Medicaid differs by state so it may be slightly different where he lives.
Medicaid programs are uniquely run by each State but under overall federal guidelines. Most States Medicaid limit dental to preventative services for kids or for care needed from a trauma. If your dads NH actually has a dentist that comes regularly to the facility (this is amazing if happening as it’s really hard to work on patients with dementia which lost in a NH have), ask them to evaluate him. Your dad gets a monthly personal needs allowance if he is on LTC Medicaid; tends to run $50-60 for most states. He can use this $ to pay for the consultation with the dentist.
I don't think Medicaid would allow a tooth replacement. Lots of work goes into getting one put in. The partial? The one that was suggested to my husband was grounding down the two teeth on each side of the missing tooth. Then making a mold that would slip over the two teeth with the new one between them. I think it would be permanent like 2 crowns. Problem, now susceptible to needed root canals in the future.
https://www.chcs.org/media/Medicaid-Adult-Dental-Benefits-Overview-Appendix_091519.pdf
The US Gov ONLY required Medicaid-covered dental care for those 21 and younger! Each state, "Individuals Age 21 and older: States may elect to provide dental services to their adult Medicaid-eligible population or, elect not to provide dental services at all, as part of its Medicaid program. While most states provide at least emergency dental services for adults, less than half of the states provide comprehensive dental care. There are no minimum requirements for adult dental coverage.
https://www.hhs.gov/answers/medicare-and-medicaid/does-medicaid-cover-dental-care/index.html
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