What adult Medicaid actually covers, state by state

No dental benefit for non-pregnant adults 21+; dental is covered only for children under 21 (EPSDT) and for pregnant/postpartum beneficiaries (since 10/1/2022). source

Covered Services Handbook: routine partials, dentures, bridgework, crowns, and periodontal surgery are not covered for adults. source

Adults 21+ get one complete eye exam and one pair of eyeglasses every two calendar years; contact lenses only with prior approval. source

Covered Services Handbook: Medicaid does not cover hearing services (including hearing aids) for recipients aged 21 and older. source

Emergency dental plus Adult Enhanced Dental benefit up to $1,150/benefit year (Jul 1-Jun 30) covering preventive and restorative care incl. cleanings, exams, crowns, root canals, dentures; emergency care doesn't count toward the cap. source

Dentures covered under the Adult Enhanced Dental benefit but within the $1,150/yr cap; adults 21+ may combine two benefit years to obtain full upper and lower dentures/partials. source

One routine vision exam per calendar year; adults 21+ get one complete pair of eyeglasses per two calendar years (extra pair if medically necessary and authorized). source

Adult hearing services include hearing aids (with approved accessories/supplies) and repairs; must be prescribed/ordered by a physician or qualified practitioner. source

Emergency dental only for adults 21+, capped at $1,000/contract year (Oct 1-Sep 30): exams, x-rays, extractions, treatment of acute pain/infection; routine restorative and routine root canals excluded (AMPM 310-D1). source

AMPM 310-D1 limitations for adults 21+ state flatly: 'Dentures are not covered' (fixed bridgework also excluded). source

No routine adult vision benefit: vision exams and glasses are covered only for members under 21; adult eye care only when medically necessary (e.g., cataracts, glaucoma). source

Hearing aids are covered only for children under age 21; no adult hearing aid benefit. source

Adults 21+ capped at $500/state fiscal year for covered dental services (extractions and dentures sit outside the cap); endodontic therapy, sealants, and pulpotomies are not covered for adults. source

Full and acrylic partial dentures covered outside the $500 annual cap, but only one complete upper and one lower denture (and one upper/lower partial) per lifetime; partials require prior authorization. source

Adults 21+ get one visual examination and one pair of glasses every 12 months ($2 copay; second pair for diabetics with >1 diopter change via PA). source

Hearing Services provider manual covers hearing services/aids only for beneficiaries under age 21 via EPSDT; no adult hearing aid benefit. source

Full adult dental: exams, cleanings, fillings, crowns, root canals, scaling/root planing, dentures; $1,800/yr limit that can be exceeded if medically necessary. source

Partial and full dentures plus denture relines are covered adult services. source

Routine eye exam and eyeglasses (frames + lenses) every 24 months; adult eyeglasses restored 2020-01-01. source

Covered for adults with a $1,510 cap per fiscal year (aids, molds, supplies, fittings); cap may be exceeded with prior approval for medical necessity. source

Comprehensive adult dental (exams, fillings, extractions, root canals, crowns, periodontal scaling, dentures — some need prior auth); $3,000/yr cap reinstated 2026-07-01 (was uncapped 2023-2026); emergency services and dentures don't count toward the cap. source

Partial and complete dentures covered with prior auth, excluded from the $3,000 annual cap; replacement of lost/stolen/broken dentures once per lifetime. source

Adults get annual eye exams, but eyeglasses are covered only after eye surgery (post-surgical glasses don't count as routine coverage). source

State benefits table: 'Adults age 21 and older: Hearing aids are not covered' (only exception is the SLS waiver, outside standard eligibility). source

Comprehensive adult dental via CT Dental Health Partnership: fillings, crowns (1/5yr), root canals, periodontal treatment, dentures — no hard annual cap; services beyond the $1,000/yr threshold need prior authorization for medical necessity, so classified extensive per KFF standard. source

Dentures covered once per 7-year period with prior authorization; adjustments/relines once every 2 years. source

Adults 21+: one pair of eyeglasses (frames + lenses) every two rolling years (sooner if medical condition changes); optometrist/ophthalmologist exams covered and not subject to the 2-year limit. source

Hearing aids are a basic HUSKY Health benefit for all members (adults included), reimbursed per the DSS fee schedule. source

Adult benefit capped at $1,000/calendar year (+up to $1,500 more for emergencies with state review), $3 copay/visit; covers exams, cleanings, x-rays, fillings, extractions, limited periodontics — no root canals, lab crowns, or new dentures. source

New complete/partial dentures are not on the adult benefit code list — only repairs, relines, and tooth/clasp replacement on existing dentures; per the plan-administrator benefit list (state fee-schedule page not directly verifiable), so verified=false. source

No routine adult vision in the FFS state plan; all Medicaid MCOs provide an annual routine exam, and eyeglasses are MCO value-adds (Highmark labels lenses/frames 'not standard Medicaid benefits') — most enrolled adults can in practice get glasses through their plan; MCO source, so verified=false. source

Adult hearing benefit delivered through the Medicaid MCOs: routine hearing exam plus one hearing aid per ear every 2 calendar years, no copay (Highmark/AmeriHealth); national trackers list DE as covering adult hearing aids — MCO source, so verified=false. source

Comprehensive adult dental: DHCF's current dental fee schedule (Transmittal 25-28, eff. 2025-10-01) pays adult rates for diagnostic, preventive (adult prophylaxis D1110), restorative fillings, crowns, periodontal scaling/root planing (D4341/D4342), and complete/partial dentures. source

Complete upper/lower dentures (D5110/D5120) and partial dentures (D5211) carry adult reimbursement rates on the DHCF dental fee schedule. source

Adults 21+: one complete pair of eyeglasses per 24 months (prior authorization; sooner if Rx changes >=0.50 diopter or glasses lost/broken); eye exams for 21+ are covered when medically necessary for a chronic or acute eye condition rather than as a purely routine screening (DHCF Transmittal 18-24). source

DHCF lists 'hearing services, including hearing aids' among covered Medicaid services for adult managed-care enrollees; KFF reports utilization review required prior to service. source

Adults 21+ get acute emergency dental only - problem-focused exams, x-rays, incision/drainage of abscess, and extractions to relieve pain or infection; the one exception is dentures and denture-related procedures, which are covered (see dentures). source

Full and partial dentures plus denture-related procedures (including comprehensive oral evaluation and mouth preparation) are covered for recipients 21 and older; the coverage policy limits complete dentures to one upper and one lower per lifetime. source

Adults 21+: one frame every two years and two lenses per 365 days; visual exams (up to two refractions per 365 days) are covered when a vision problem, illness, or injury is reported per the Visual Care Services policy. source

Hearing aids are a covered benefit (no under-21 restriction): one new hearing aid per ear every three years for recipients with moderate or greater hearing loss, plus fittings, ear molds, repairs, and replacements. source

Expanded from emergency-only effective 2024-07-01: the approved state plan (SPA GA-24-0005) covers diagnostic, preventive, restorative, periodontal, prosthodontic, endodontic, emergency, and oral surgery services for adults 21+; the DCH Adult Dental SPA public notice (dch.georgia.gov) confirms removal of adult procedure limitations. source

Prosthodontic services (complete and partial dentures) are included in the adult 21+ dental benefit effective 2024-07-01 per approved SPA GA-24-0005; state plan document is hosted on medicaid.gov because the GAMMIS dental manual PDF is portal-gated. source

No routine adult vision benefit: routine eye exams/refractions and eyeglasses are covered only under EPSDT for members under 21; adult eyeglasses are limited to medical-necessity cases (KFF) and CMOs offer small adult vision extras only as value-added benefits. Could not verify on a live state page (GAMMIS Vision manual is portal-gated), so marked unverified. source

Hearing aids are not covered for adults 21+ (KFF benefits survey: 'Hearing aids not covered'); coverage exists only for children under 21 via EPSDT/Children's Intervention Services. Primary state manual is portal-gated, so marked unverified. source

Comprehensive adult dental restored effective 2023-01-01: preventive, diagnostic/radiology, restorative, endodontic, periodontal, oral surgery, prosthodontic, and emergency/palliative services for members 21+. source

Prosthodontic services are a listed adult benefit, but the 2025 QUEST member handbook states 'Limited prosthodontic services will be allowed based on medical necessity.' source

Provider manual Ch. 20: vision exams and prescription lenses covered; frames covered; adult refractions and new lenses limited to once per 24 months (12 months under 21). source

Provider manual Ch. 20: hearing aids covered for adults with prior authorization (ENT evaluation required); monaural for 21+ (binaural limited to under 21); replacement every 3 years. source

IDAPA 16.03.26 sec. 293.02: adults covered for preventive screenings, exams, diagnostic, restorative, periodontics, prosthodontics, dentures, and oral surgery with no annual dollar cap; root canals and crowns are excluded for adults. source

IDAPA 16.03.26 sec. 293.02 explicitly lists dentures among covered adult dental services (administered by MCNA under Idaho Smiles, no adult benefit maximum). source

Eye and Vision Services provider handbook: participants 21+ are 'not eligible for routine eye exams, eyeglasses, and contact lenses'; exceptions are chronic-condition monitoring exams (e.g., diabetes) and one pair of glasses after cataract surgery. source

Audiology Services provider handbook: 'Only participants under the age of twenty-one (21) are eligible to receive audiometric testing and hearing aid services'; adults 21+ get differential-diagnosis testing only. source

HFS Dental Office Reference Manual (2023) covers adults 21+ for exams (1/12mo), annual cleaning (D1110), fillings, crowns, anterior root canals (D3310), periodontal scaling/root planing and surgery, extractions — no annual dollar cap. source

Complete and immediate dentures covered for adults 21+, one per 60 months with prior authorization; relines once per 24 months (HFS Attachment S adult benefits list). source

Medically necessary exams not limited; adults 21+ get one pair of eyeglasses per two-year (730-day) period, with an extra pair allowed post-surgery (e.g., cataract) via prior approval (Optometric Services handbook O-212.7.1). source

HFS Audiology Services handbook covers hearing aid testing, fitting, sale, batteries and repairs with audiometric criteria (e.g., ≥25 dB loss at one of 500/1000/2000 Hz in sound suite) and no adult age exclusion; binaural/second aid requires prior approval. source

IHCP Dental Services module covers adults 21+ for exams, annual prophylaxis, fillings (amalgam/composite), periodontal scaling/root planing and surgery, extractions and dentures with no annual dollar cap; no endodontic (root canal) or permanent-crown coverage for adults. HIP Plus includes this dental benefit; HIP Basic (21+) excludes dental. source

Complete and partial dentures covered for members of all ages, once every six years, prior authorization and medical necessity required (60-day post-extraction wait except PA'd immediate dentures for 21+). source

Adults 21+ get one eye exam every two years and one pair of eyeglasses every five years if minimum prescription criteria are met (IHCP Vision Services module). HIP Plus includes vision; HIP Basic (21+) excludes it. source

IHCP reimburses hearing aid purchase for adults per 405 IAC 5-19-13 with prior authorization; denied for an ear with pure-tone average ≤30 dB, canal-style aids excluded, replacements also require PA (405 IAC 5-19-15). source

Dental Wellness Plan covers exams, cleanings, x-rays, fillings, root canals, surgical/non-surgical gum treatment, crowns, dentures and extractions for adults; tiered 'earned benefits' ended (Healthy Behaviors dropped 2023-07-01); $1,000/benefit-year ABM applies at 21+ but diagnostics, preventive, dentures, sedation and emergent care are exempt (Comm. 711). source

Complete, immediate and partial dentures plus adjustments, repairs, rebases and relines are covered (Comm. 712 code list) and are excluded from the $1,000 annual benefit maximum (Comm. 711). source

Routine eye exam covered once per 12 months for all members; eyeglass lenses and frames covered for adults (new lenses/frames once every 24 months for age 8+, replacement of lost/damaged glasses once per 12 months at 21+), per the Optometrist and Optician Services Provider Manual. source

Hearing aids covered for adults (physician-exam requirement waivable at 18+); PA required only for monaural aids >$650, binaural >$1,300, or replacement sooner than 4 years for members 21+, per the Audiologist and Hearing Aid Dispenser Provider Manual. source

KMAP Dental Manual Exhibit C (Title 19 Adult, upd. 07/26) covers exams, x-rays, cleanings, fluoride, sealants, fillings, crowns, periodontal care (SRP, gingivectomy, perio maintenance), dentures and oral surgery with no annual dollar cap; gaps remain — no endodontics (root canals) for adults and extractions only when medically necessary. source

Full and partial dentures (D5110-D5286) plus adjustments and repairs covered for adults meeting medical-necessity criteria; prior authorization required and existing prosthesis must be >=5 years old and unserviceable for replacement. source

Vision FFS Manual sec. 8400: one complete eye exam per 365 days and one set of lenses plus one pair of frames per year for non-KBH-EPSDT (adult) members — general adult coverage, not limited to post-cataract/aphakia. source

Audiology FFS Manual sec. 8400: initial hearing aid covered without PA for adults; replacement limited to once per 4 years (with PA); binaural fitting for adults restricted to special cases (legally blind, prior binaural user, occupational need). source

CHFS describes adult coverage as 'limited but includes oral exams, emergency visits, X-rays, extractions, dentures, implants, and fillings' — restorative yes, but no crowns, endodontics, or periodontal listed. source

Dentures (and implants) are explicitly listed as covered adult dental services on the CHFS Dental Services (PT 60) page; limits per 907 KAR 1:126. source

Vision fee schedule: 'Vision benefits expanded to adults effective 1/1/2023 - all codes payable to adults and children'; exam codes 92002-92014 and frames/lenses (V2020 etc.) payable for adults, one pair of eyeglasses per calendar year. source

907 KAR 1:038 amendment struck the under-21 age restriction; hearing instruments covered up to $1,200 per ear every 36 months with physician referral (also stated on CHFS Hearing Aid Dealer PT 50 page). source

Standard adults 21+ get Adult Denture Services only — exam and X-rays covered solely in conjunction with a Medicaid-authorized denture; no preventive, restorative, or palliative dental. Comprehensive dental exists only for I/DD waiver enrollees; MCO value-adds (e.g. $500 allowances) are not the state-plan benefit. source

Adult Denture Program (adults 21+): dentures, relines, and repairs; one complete or partial denture per arch per 8-year period, partial must oppose a full denture. source

For recipients 21+, LDH lists routine eye exams for vision correction/refraction and eyeglasses as NON-COVERED; only medical treatment of eye conditions (infections, cataracts, etc.) is covered. source

DME provider manual §18.2.15 (issued 06/25/25): 'Hearing aids are only provided to eligible beneficiaries under 21 years of age (EPSDT eligibles)'; standard adults are excluded (waiver programs excepted). source

Comprehensive adult benefit (added July 2022): diagnostic, preventive, restorative, endodontic, periodontal (incl. SRP and periodontal maintenance), oral surgery and prosthodontic services per MaineCare Benefits Manual Ch. II Sec. 25; no annual dollar cap. source

Sec. 25.03-6: complete, partial and immediate dentures covered once per arch per 5 years with PA (immediate dentures once per lifetime per arch); includes 6 months post-delivery care, plus ongoing adjustments/repairs/relines; fixed prosthodontics (bridges) remain under-21 only. source

Sec. 75: adults 21+ get one routine eye exam per 3 rolling years (more if medically indicated), but eyeglasses are excluded for 21+ except one pair per LIFETIME at power >= 10.00 diopters — not standard glasses coverage. source

Sec. 60 (Medical Supplies & DME) 60.08-12: members 21+ eligible for one hearing aid or one replacement pair every 5 years; PA required per 60.06-2; must be purchased via state-contracted vendor after 30-day trial. source

Maryland Healthy Smiles adult benefit (since Jan 2023): checkups, cleanings, X-rays, fillings, fluoride, crowns, root canals, extractions, anesthesia; no annual maximum, no copays — comprehensive restorative coverage. source

State page explicitly lists 'Dentures for adults 21+' as NOT covered; only denture adjustments are covered for adults (a 2024 legislative rate study on adding dentures exists, but coverage has not launched). source

Vision Care Services (COMAR 10.09.14, per Jan 2026 provider manual): adults 21+ get one optometric exam every 2 years, but eyeglasses, ophthalmic lenses, optical aids and optician services are excluded for participants 21 or older (some MCOs add glasses as an extra benefit). source

Covered for adults since Oct 2018 (COMAR 10.09.51): unilateral aid medically necessary for 21+ at pure tone average >= 40 dB in the better ear (bilateral with added criteria); replacements every 5 years; cochlear/osseointegrated devices also covered. source

Comprehensive adult benefit (exams, cleanings, fillings, crowns, root canals, dentures, periodontal); $1,750 yearly coverage limit for adults 21+ effective 2026-08-01. source

Dentures/partial dentures/plates covered for adults 21+ with no prior authorization; immediate (temporary) dentures not covered for adults; first full dentures after extractions exempt from the $1,750 cap. source

Adults 21+: eye exam once every 24 months and one pair of new eyeglasses once every 24 months, no prior authorization. source

Hearing aid and dispensing services covered under MassHealth Standard, CommonHealth, Family Assistance, and CarePlus. source

Redesigned adult (21+) benefit effective 2023-04-01 covers X-rays, cleanings, fillings, extractions, dentures, deep cleanings, sealants, root canals, crowns, and periodontal care; no annual dollar cap. source

Complete, immediate complete, and partial dentures are a covered benefit for all beneficiaries, subject to a five-year frequency rule (Medicaid Provider Manual, Dental ch., v. 2026-07-01). source

Routine eye exam once every two years without PA; complete pair of eyeglasses is a benefit with adults 21+ limited to one replacement pair per year (Medicaid Provider Manual, Vision ch., v. 2026-07-01). source

One monaural or two binaural hearing aids covered once every five years; adults 21+ qualify at 30 dB HL loss with functional impact, copay may apply (Medicaid Provider Manual, Hearing Services ch., v. 2026-07-01). source

MA covers medically necessary dental for adults with no annual dollar cap: exams, x-rays, prophylaxis, fillings, oral surgery, endodontics, periodontics, crowns, dentures and implants (Minn. Stat. 256B.0625 subd. 9; Minn. R. 9505.0270). source

Removable full and partial dentures are covered dental services; initial placement or replacement limited to once every 3 years per patient (relines/rebases also covered) (Minn. R. 9505.0270 subp. 2, 2a). source

Comprehensive and intermediate vision examinations plus medically necessary eyeglasses (correction >= .50 diopters) are covered for adults (Minn. R. 9505.0277; Minn. Stat. 256B.0625 subd. 12). source

Hearing aids (monaural or binaural) covered for adults after physician exam and audiologic evaluation; replacement limited to once every 5 years without prior authorization (Minn. R. 9505.0287). source

Non-EPSDT adults get only emergency extractions/treatment, dental care adjunct to an acute medical condition, and jaw-related surgery; preventive care, fillings, crowns and endodontics are non-covered; $2,500/beneficiary/state-fiscal-year cap (Miss. Admin. Code Part 204 Rules 1.1, 1.4, 1.5; SPA 23-0030 eff. 10/01/2023). source

Dentures are listed as a non-covered dental service for adults; covered only for EPSDT-eligible (under-21) beneficiaries with prior authorization (Miss. Admin. Code Part 204 Rule 1.4; SPA 23-0030). source

Eye exams covered for all eligible beneficiaries, but one refraction and one complete pair of eyeglasses only every 5 years for adults; repairs/replacements not covered (Miss. Admin. Code Part 217 Rules 1.1, 1.5, 3.1). source

Hearing Services code (Part 218) covers only cochlear implants and auditory osseointegrated devices; conventional hearing aids have no adult benefit and are payable only for EPSDT-eligible (under-21) beneficiaries. source

Adult Limited Dental Benefit Package (restored eff. 2016-01-01): exams, x-rays, cleanings, fillings, extractions, perio scaling; no root canals, lab crowns, or dentures for standard adults. source

Full and partial dentures are covered only for pregnant women, blind, and skilled nursing facility residents - not for standard adults 21+ (excluded even under trauma/medical-condition criteria). source

Adults 21+ get one eye exam every 24 months and one pair of complete eyeglasses every 2 years (lens replacement allowed for a 0.50+ diopter change). source

Covered for adults effective 2025-08-28 (SB 79): hearing aids and related services added for adult categories including the E2 Adult Expansion Group; cochlear implants also covered. source

Standard adults have a $1,125/year cap on dental TREATMENT services; anesthesia, dentures, diagnostic, and preventive services are exempt from the cap; exams and cleanings every 6 months. source

Dentures covered and exempt from the annual cap: partial dentures replaceable every 5 years, full dentures every 10 years; one lost pair covered per lifetime. source

Effective 2024-07-01, adults 21+ get one eye exam, one pair of eyeglasses, and one pair of medically necessary contact lenses every 365 days. source

Hearing aids, repairs, and some related items covered when ordered by a provider; dispenser needs prior authorization; OTC hearing aids not covered. source

$750/yr adult cap eliminated effective 2024-01-01 (SPA NE-24-0001, approved 2024-02-21); comprehensive benefit incl. diagnostic, preventive, restorative, endodontics, periodontics, dentures. source

Complete, immediate, and resin-base partial dentures covered (471 NAC 6 s.004.02(F)); paid incrementally per treatment stage since 2024; no annual dollar cap since 2024-01-01. source

Adults 21+: eye exam once every 24 months; one pair of eyeglass lenses per coverage period and frames once every 24 months (471 NAC 24). source

Adults 21+: hearing aids covered, limited to one aid per ear every 4 years when medically necessary; prior authorization over $500.01/unit (471 NAC 8). source

Expanded effective 2026-07-01 (SB 385): diagnostic, preventive, periodontal, and operative (fillings/crowns) under a $1,000/calendar-year cap; emergency, palliative, and dentures outside the cap; no endodontics or non-emergency extractions. source

Prosthetic (dentures/partials) care covered when medically necessary and NOT subject to the $1,000 annual limit; one new full or partial denture per 5 years (MSM Ch. 1000). source

Routine eye exams covered for all ages once every 12 months; lenses and frames covered for all ages (21+ need prior authorization to exceed the 12-month lens limit) - MSM Ch. 1100 eff. 2025-02-26. source

Hearing aids and supplies covered once every 24 rolling months; adults must have >=30 dB hearing loss at 500-3000 Hz (MSM Ch. 2000). source

Adult NH Smiles benefit (eff 2023-04-01, NE Delta Dental/DentaQuest): exams, x-rays, cleanings, fillings, gum treatment, extractions/oral surgery; $1,500/yr cap excluding preventive services. source

Removable partial/full dentures limited to DD, ABD, and CFI waiver participants and nursing facility residents — not available to standard-eligibility adults 21-64. source

Eye exams covered; one refraction per 12 months and one pair of lenses with frames at refractive error >= +/-0.50 diopter, with no adult age exclusion (only lost-glasses replacement excluded for 21+). source

He-W 567.05: least-costly monaural aid for adults 21+ with bilateral loss averaging >=35 dBHL (1000-4000 Hz); binaural requires PA plus work/school/blindness criteria; eval 1 per 2 years; batteries, repairs, replacements covered. source

Comprehensive adult dental (diagnostic, preventive, restorative, oral surgery, prosthodontics) per DMAHS covered-services list and N.J.A.C. 10:56; no annual dollar cap, prior authorization for major services. source

Complete and partial dentures prior-authorized when masticatory deficiencies are likely to impair general health (N.J.A.C. 10:56-2.13); 3-month post-extraction healing wait, ~7.5-year replacement interval. source

NJ FamilyCare covers vision care including optometry services, and eyeglasses are an explicitly listed covered benefit for adults. source

DMAHS covered-services list includes hearing services, including hearing aids, for NJ FamilyCare members. source

Adults 21+ get exam 1x/12mo, X-rays, cleaning 1x/12mo, fluoride, fillings, prefab crowns, perio scaling, extractions; no root canals, lab crowns, fixed bridges, or implants (8.310.2.12(G) NMAC). source

New/replacement dentures not covered for 21+ (EPSDT under-21 only); only repairs and 2 adjustments per 12 months of existing dentures are covered (8.310.2.12(G)(8) NMAC). source

Routine exam, corrective lenses, and frames each 1x per 36 months for 21+; lenses require minimum diopter correction (e.g., -1.00 myopia) per 8.324.5.12(A) NMAC. source

Purchase, repairs, batteries, and insured replacement covered for adults; binaural (both ears) only if in school, employed/seeking work, prior binaural user, or legally blind (8.324.5.12(B) NMAC). source

State calls it an "extensive dental services benefit" for all members; effective 2024-01-31 coverage expanded for root canals, crowns, replacement dentures, and dental implants; no annual dollar cap. source

Complete and partial dentures covered; replacement dentures covered since 2024-01-31 with prior approval plus a Justification of Replacement Dentures form. source

Eye exam and one pair of eyeglasses every 2 years; sooner allowed for medical conditions or a prescription change of at least 0.50 diopter. source

Covered with documented medical need and hearing loss >= 30 dBHL in the better ear; prior approval required; binaural aids need extra criteria (vocational/educational demand, prior binaural use, or visual impairment). source

Policy 4A covers ~242 CDT codes with no annual dollar cap: exams, cleanings, fillings, crowns (prefab, max 6/visit), perio, oral surgery, dentures; root canals for 21+ limited to anterior teeth. source

One complete/immediate denture per arch every 10 years (partials every 8 years), prior approval required; no temporary/interim dentures. source

Routine eye exam with refraction once every 2 years and visual aids (eyeglass frames + lenses) once every 2 years for 21+ (Policy 6B). source

Policy 7: "Medicaid shall not cover Hearing Aid Services... for beneficiaries 21 years of age and older" - hearing aids are an under-21 (EPSDT) benefit only. source

Comprehensive adult benefit, no annual dollar cap: exams, cleanings, fillings, perio scaling, anterior-only root canals/crowns (SA required), extractions, dentures; Medicaid Expansion adults (BCBSND plan) get accident/surgical dental only. source

One upper and one lower complete denture every 5 years (no SA within limit); all partial dentures and early replacements require service authorization. source

Adults 21+: one eye exam with refraction and one pair of eyeglasses every 2 years (contract frames/lenses); sooner requires service authorization. source

Adults 21+ with average hearing loss >= 40 dB (500/1000/2000 Hz); service authorization required; replacement no sooner than 5 years; binaural allowed if medically necessary. source

Comprehensive adult benefit, no annual dollar cap: exams, cleanings (1 per 180 days), x-rays, fillings, crowns, root canals (anterior through molar), perio scaling, extractions, dentures; $3 copay per visit. source

Complete and partial dentures covered 1 per 8 years per arch; prior authorization required (resin-base partials only under age 19). source

Ages 21-59: one comprehensive exam plus one complete frame and lenses every 24 months (every 12 months at 60+); more frequent requires PA; $2 exam copay. source

Covered for adults with >= 31 dB loss in at least one ear; Certificate of Medical Necessity (ODM 01915) plus hearing evaluation within 6 months required; includes earmold, cleaning kit, first month's batteries. source

Adult Limited Dental Benefit: cleanings/fluoride, silver and tooth-colored fillings, extractions, full/partial dentures; no crowns or root canals for adults; $4 copay per non-emergency visit. source

Full and partial dentures explicitly covered for adults 21+ under the adult dental benefit (same benefit for expansion adults 19-64). source

Adults 21+: vision services covered for eye diseases or eye injuries only — no routine exams, refractions, or eyeglasses. source

Adults 21+: hearing evaluation only; hearing aids covered only when provided within nursing facilities (institutional, not standard adult benefit). source

Comprehensive adult benefit for all OHP members: checkups, x-rays, cleanings/fluoride, fillings, extractions, stainless-steel crowns, specialist and urgent/emergency care; no annual dollar cap. source

Full dentures every 10 years; partial dentures every 5 years. source

Routine refraction exam once every 24 months for adults 21+; glasses/contacts for non-pregnant adults only for specific medical conditions (aphakia, keratoconus, missing natural lens, post-keratoplasty). source

Hearing aids and related batteries, dispensing, fitting and repair covered; hearing services by licensed physician, audiologist, or hearing aid specialist. source

Exams, x-rays, cleanings (1 per 180 days), fillings, extractions and oral surgery; root canals, crowns and periodontal services covered only with an approved Benefit Limit Exception (BLE). source

Complete and partial dentures limited to one per lifetime without an approved Benefit Limit Exception. source

Optometric eye exams are a covered MA service (55 Pa. Code Ch. 1147), but eyeglasses are paid only for recipients age 20 or younger (55 Pa. Code 1123.56); HealthChoices MCOs typically allow 2 exams/yr. source

Payment for hearing aids made only if recipient is 20 or younger and prescribed via EPSDT (55 Pa. Code 1123.57); no adult FFS benefit. source

FFS adult benefit, no annual cap: 2 exams + 2 cleanings/yr, x-rays, fillings, anterior root canals, periodontal scaling (PA required), extractions, oral surgery, dentures; no crowns (except stainless steel) and no molar/premolar root canals. source

Complete and partial removable dentures covered, including adjustments and relines; type and frequency limits apply (bridges/implants not covered). source

For adults 21+: one refractive eye exam plus one pair of eyeglasses (or one pair of contacts) per 24-month period. source

Covered as DME for adults, billed with a prescriber's Certificate of Medical Necessity; state FFS fee schedule pays hearing-aid codes (e.g., V5261 binaural digital BTE, $1,050 allowed) with no adult age restriction. source

Adult benefit = diagnostic, preventive, restorative, extractions and adjunctive services only; preventive/restorative/extractions capped at $1,000 per state fiscal year (diagnostic and adjunctive excluded from cap); no endodontics or prosthodontics. source

Complete and partial dentures (D5110-D5212) listed as 'Not a covered service' for Adult 21+; covered only for children 14-20 and ID/RD waiver members. source

Routine vision services (routine eye exams, refractions, corrective lenses, glasses) are non-covered for members 21+; only disease-related eye care (e.g., glaucoma, cataracts) is covered as medical. source

Hearing aids and accessories limited to children under 21 (prior-auth through SCDPH); adults 21+ covered only via ID/RD or HASCI waivers (cochlear implants are a separate 21+ benefit). source

Broad adult benefit (exams, cleanings, fillings, crowns, front-tooth root canals) capped at $2,000/yr (Jul-Jun); emergency, preventive, and dentures are exempt from the cap. source

Full and partial dentures covered no more than once every 5 years and exempt from the $2,000 annual cap. source

Eye exams/refractions covered with no age restriction; lenses (single/bifocal/trifocal) covered, with replacement only after 15 months and a medically necessary lens change (frames only with a medically necessary lens change). source

Hearing aids covered for adults (monaural/binaural; BiCROS ages 0-99) with >=30 dB loss; replacement after 3 years for age 21+. source

Comprehensive adult (21+) dental added 2023-01-01: exams, X-rays, cleanings, fillings, crowns, root canals, extractions, gum-health services, at no cost for covered medically necessary care. source

Adult covered-codes list includes complete dentures (maxillary/mandibular), partial dentures, relines, and repairs. source

21+ limited to medical eye care; routine exams, refractions, and eyeglasses are excluded (one pair of cataract glasses after cataract surgery is the only eyewear exception). source

Hearing aids (prescribing, fitting, changing) are excluded for members 21+; cochlear implants are covered separately when medically necessary. source

Standard adults get only emergency dental in a hospital/ambulatory surgical center (dislocated jaw, traumatic tooth damage, cyst removal, oral abscess); routine adult dental is not a state-plan benefit (comprehensive dental ends at 21 with Texas Health Steps). source

No adult denture benefit in the state plan (adult dental is emergency-only per KFF/ADA); dentures exist only as a STAR+PLUS HCBS waiver add-on, not standard eligibility. No live state source states the exclusion explicitly. source

Adults 21+ get a routine eye exam with refraction once every 24 months and eyeglasses once every 24 months (earlier with a documented >=0.5 diopter change). source

Medically necessary hearing aids covered at any age; 21+ limited to one aid per 5 years with >=35 dB loss in both ears (binaural devices only for 20 and younger). source

Dental is covered for all adult Medicaid members (SB19 expansion): preventive care every 6 months, fillings, crowns and root canals for certain teeth, extractions; some specialty services need prior authorization. source

Full or partial dentures listed as covered services for Medicaid members. source

One eye exam per year covered; eyeglasses only for pregnant members and EPSDT (under-21) members - not for standard adults. source

Speech and hearing services (incl. hearing aids) limited to pregnant members and EPSDT-eligible members; no adult hearing-aid benefit. source

Adult benefit capped at $1,500/calendar year (2 preventive visits exempt); covers fillings, endodontics, and periodontal scaling but excludes cast/processed crowns, bridges, periodontal surgery, and dentures; emergency services covered after the cap. Borderline vs KFF 'extensive' given the >=$1,000 cap - classified limited for the crown/denture exclusions. source

Complete/partial denture codes (D5110-D5214) are marked 'N' for the standard Adult Program; dentures covered only for DDS/SMI waiver groups and pregnant/postpartum members. source

One comprehensive + one intermediate eye exam (or two intermediate) per 24 months; eyewear coverage is limited to members under 21. source

Hearing aids covered - one per ear every three years for specified degrees of hearing loss. source

Comprehensive adult (21+) dental via Cardinal Care Smiles since 2021-07-01: X-rays, exams, cleanings, fillings, root canals, gum treatment, extractions/oral surgery; no annual dollar cap published. source

Dentures explicitly listed among covered adult Cardinal Care Smiles services. source

Routine comprehensive eye exams covered for adults (AAO frequency); eyeglasses covered only for members under 21 (MCOs may add a glasses allowance as an extra benefit). source

State plan reimburses adult audiology for diagnostic purposes only (practitioner-referred); hearing-aid devices are covered only under EPSDT (<21). Many Cardinal Care MCOs add a hearing-aid allowance as an extra benefit. source

Adults 21+ covered fee-for-service: exams, cleanings, X-rays, fillings, fluoride, extractions, front-tooth root canals, stainless steel crowns, dentures/partials; excludes bridges, porcelain crowns, molar root canals, implants. source

Dentures/partials listed among covered adult dental services (fee-for-service via ProviderOne). source

Eye exams (incl. refraction/visual fields) provided for adults through the health plan; eyeglass frames and lenses are NOT covered for adults - only discounted via HCA's contractor CI Optical. source

Adults 21+ covered since ESSB 5179: one hearing aid every 5 years (second aid if criteria met), repairs/replacement, plus adult cochlear implants since 2024-01-01. source

Adults 21+ get emergent care plus diagnostic/preventive/restorative services capped at $2,000 per member per two fiscal years (effective 2024-07-01, prior authorization required); cosmetic excluded; member pays beyond the cap. source

Dentures are included in the expanded adult benefit (Ch. 505 App. C) but consume the dollar cap - getting dentures can exhaust the benefit for other services. FAQ still cites the pre-2024 $1,000/yr cap; current cap is $2,000/2 fiscal years. source

Adult eye exams limited to medical necessity only (no routine exams); eyeglasses only within 60 days after documented cataract extraction; adult contact lenses only for keratoconus/aphakia. source

Hearing aids covered only for members up to 21; Ch. 530 lists hearing aids, evaluations, and fittings for members 21+ as non-covered. source

Dental care is a covered BadgerCare Plus/Medicaid service with no annual dollar cap; ForwardHealth covers root canals (molar endo for 21+ needs PA), crowns (once/5 yrs permanent teeth), and periodontal scaling/root planing (once/3 yrs per quadrant, PA). source

Full and partial dentures covered once per five years with prior authorization (partials require good oral/periodontal health and favorable prognosis). source

BadgerCare Plus covered-services list includes 'Eye care. Includes eyeglasses.' for members (exams + glasses). source

ForwardHealth covers medically necessary hearing instruments for adult members (most need PA; one dispensing fee per ear per 12 months; ~5-year life expectancy before routine replacement). source

Adults get preventive visits (basic cleanings, exams, X-rays), extractions, and repair/realignment of existing dentures; no restorative services (no fillings/crowns/root canals). source

Only repair/realignment (reline) of EXISTING dentures or partials is covered; new dentures are not an adult benefit. source

Adult vision limited to exams/office visits for eye disease or injury (e.g., macular degeneration); routine exams not covered and glasses/contacts explicitly not covered for adults (comprehensive services end at 21). source

Audiologist services and hearing aids covered once every five years (with exceptions). source