Does Medicaid Cover Dentures in Virginia? Cardinal Care Rules

Yes, Medicaid covers dentures in Virginia. Full dentures, partial dentures, and denture repairs are covered services for adults and children enrolled in Cardinal Care, the state’s Medicaid program, at no out-of-pocket cost.¹ A dentist has to document that the dentures are medically necessary, and the request goes through a prior authorization process run by DentaQuest, the state’s dental benefits administrator. Adult denture coverage has been in place since July 1, 2021, when Virginia expanded dental benefits beyond emergency-only extractions.²

Who Qualifies

Most adults ages 19 through 64 qualify for Cardinal Care if household income is below 138 percent of the federal poverty level. For 2026, that comes out to roughly $22,025 a year for one person or $45,540 for a family of four.³ If you already have full-benefit Medicaid, dental services are built in. There’s no separate dental plan to sign up for.

Children and teens under 21 qualify at higher income levels through Medicaid for Children and FAMIS, which reaches further up the income scale than the adult program.⁴⁵⁶ If a child needs dentures because of trauma, a congenital condition, or severe decay, Medicaid must cover them.

What Denture Coverage Actually Includes

For adults, covered services include full dentures, partial dentures, and repair procedures.⁷ If teeth need to come out before dentures can be placed, oral surgery and extractions are covered under the same benefit. The governing regulation is 12VAC30-50-190.⁸

The medical necessity standard means the dentures have to restore function, not just improve appearance. There is no copayment for covered dental work under Cardinal Care.¹

How to Get Dentures Through Cardinal Care

Start by making sure your Cardinal Care ID card is current. If you’re still holding an older Medicaid card, contact your managed care organization or DMAS for a replacement.⁹

Next, find a dentist in the DentaQuest network. Virginia’s Medicaid dental services run through DentaQuest under the Cardinal Care Smiles program.¹⁰ You can search by zip code on the DentaQuest website or call member services at 888-912-3456. Dentists enroll directly with DentaQuest rather than through the managed care plans.¹¹

After your dental exam, the dentist submits a prior authorization request to DentaQuest with X-rays, clinical notes, and a medical necessity explanation. You don’t file this yourself. Incomplete submissions are a leading reason requests stall, so it’s worth confirming with the office that all imaging is attached before it goes.

How Long Prior Authorization Takes

As of January 1, 2026, DentaQuest has to decide standard prior authorization requests within seven calendar days. Urgent requests, where a delay could seriously affect your health or ability to function, must be decided within 72 hours.¹² You’ll get a written notice either way.

Once approved, expect several appointments: impressions, try-ins, adjustments, and delivery. DentaQuest pays the dentist directly. The most frequent reasons requests get denied are missing patient information, inadequate X-rays, eligibility gaps, and requests that exceed frequency limits. A dentist familiar with Medicaid patients will usually head these off before submission.

Repairs, Relines, and Replacements

Repairs to a cracked or broken denture, or a broken clasp on a partial, are covered.⁷ Your dentist submits the repair claim through DentaQuest.

Replacement dentures are subject to frequency limits, and whether an early replacement is approved depends on clinical circumstances and DentaQuest’s review. If your denture no longer fits or has been damaged before the standard window, your dentist can request an exception with documentation of the need. A reline, which reshapes the inside of the denture to match changing gum tissue, is often approved on a shorter cycle and may be the better fix than a full replacement. Both relines and early replacements go through prior authorization.

If Your Request Is Denied

A denial can be appealed. You have 35 days from the date on the denial notice to request an appeal hearing (30 days plus five for mailing). If you file within 10 days of the notice, or before the denial’s effective date, your existing dental coverage continues while the appeal is pending. Miss that 10-day window and benefits may not continue during the appeal.¹³

The hearing is run by an impartial officer, and a representative from DMAS or the contractor that made the decision has to attend. You can review your case file and every document that supported the denial before the hearing. If the original request was denied for missing paperwork, this is when you supply additional X-rays, a stronger medical necessity letter from your dentist, or whatever else was absent. Documentation-based denials often turn around at this stage. Virginia’s timelines sit within the federal Medicaid fair hearing framework, which guarantees a hearing on any denied or delayed claim.¹⁴

1
Department of Medical Assistance Services. Dental – Adults
2
Department of Medical Assistance Services (DMAS). More Than 750,000 Virginia Adults Gain New Medicaid Dental Benefit
3
HHS ASPE. 2026 Poverty Guidelines – 48 Contiguous States
4
CoverVA. Medicaid for Children and FAMIS
5
eCFR. 42 CFR 440.40
6
Medicaid.gov. EPSDT – A Guide for States
7
Department of Medical Assistance Services (DMAS). Clarification for Adults Enrolled in Dental Medicaid
8
Virginia Code Commission. Virginia Administrative Code 12VAC30-50-190 – Dental Services
9
Department of Medical Assistance Services (DMAS). General Update on Cardinal Care
10
Department of Medical Assistance Services. Dental – Virginia Medicaid
11
Department of Medical Assistance Services (DMAS). July 1, 2025 Implementation of New Cardinal Care Managed Care Contract
12
Department of Medical Assistance Services (DMAS). Interoperability and Prior Authorization Final Rule Implementation Update
13
Department of Medical Assistance Services. Chapter M16 – Appeals Process
14
Medicaid.gov. Understanding Medicaid Fair Hearings