Pennsylvania Medicaid Dental Coverage

Adults 21 and older enrolled in Medical Assistance receive a defined benefit package. Per the Pennsylvania Health Law Project's consumer factsheet, the standard adult package covers exams and X-rays once every 6 months, teeth cleanings once every 6 months, cavity fillings, simple and surgical extractions, one complete set of upper and lower dentures in a lifetime (after April 2015), and other surgical procedures and emergency services for pain relief.

Several services are only available with a benefit limit exception (BLE). A BLE requires your treating dentist to submit a request, supported by documentation from a primary care physician or specialist showing that without the additional service your health would significantly worsen, your life would be at risk, or you would need more expensive treatment later.

In June 2025, DHS issued an operations memorandum further strengthening BLE protections. If you have one of five documented medical conditions — diabetes, coronary artery disease (or its risk factors), cancer of the face, neck, or throat (stage 2 or above), an intellectual disability, or pregnancy/the postpartum period — your BLE should be automatically approved without additional medical documentation, and your MCO cannot require you to accept a cheaper alternative treatment (such as an extraction instead of a root canal) when the recommended service is medically necessary. If you run into problems with a BLE request, contact the Pennsylvania Health Law Project Helpline at 1-800-274-3258.

If you are enrolled in a HealthChoices managed care organization, your dental benefits are administered through your MCO. Each MCO has its own dental provider network and may have slightly different procedures for prior authorizations and benefit limit exception requests. Contact your MCO directly to find participating dentists and confirm covered services.

If you receive Medical Assistance through the fee-for-service ACCESS card (not an MCO), dental claims are handled directly by DHS's Office of Medical Assistance Programs. To find a dentist who accepts Medical Assistance, visit enrollnow.net or call the Medical Assistance call center at 1-800-537-8862 (Monday–Friday, 8 a.m.–4:30 p.m.).

Dental provider participation varies significantly across Pennsylvania's regions. Rural counties tend to have fewer participating dentists than urban areas.

Penn Dental Medicine at the University of Pennsylvania School of Dental Medicine (240 S. 40th Street, Philadelphia) accepts many Medical Assistance plans and provides both preventive and restorative care. Call 215-898-8965 for appointments.

Adults residing in a nursing home or intermediate care facility are exempt from the standard benefit limits that apply to other Medical Assistance adults. This means nursing facility residents can receive a wider range of dental services — including additional dentures and certain restorative services — without going through the benefit limit exception process. Per Pennsylvania Health Law Project guidance, ask the facility's social worker or your MCO about what services are available.