Yes, Wisconsin Medicaid does cover dental care. Through BadgerCare Plus, both adults and children receive preventive, diagnostic, restorative, endodontic, periodontal, prosthetic, and emergency dental services, though adult benefits come with frequency limits, prior authorization requirements for several procedures, and a defined list of exclusions.
Who Gets the Dental Benefit
BadgerCare Plus covers pregnant individuals, children under 19, families, and adults, including childless adults who meet income requirements.1UHC. UnitedHealthcare Community Plan Wisconsin BadgerCare Plus People receiving Supplemental Security Income also qualify, and their dental coverage must be at least as comprehensive as the fee-for-service program.2ForwardHealth. SSI HMO Program Since April 2014, when the more limited Benchmark Plan was discontinued, all eligible members receive the same Standard Plan dental benefits.3ForwardHealth. BadgerCare Plus Benchmark Plan
What Adult Coverage Includes
Adults 21 and older get a defined package of dental services. The categories are broad, but almost every one carries a frequency limit, and a number of common procedures need prior authorization before treatment.
Cleanings, Exams, and X-Rays
Adult members are entitled to one dental cleaning per year. Members who are permanently disabled may receive up to four cleanings in a 12-month period.4ForwardHealth. BadgerCare Medicaid Dental Codes Topical fluoride is covered once per year, with the same increased frequency for high-caries-risk members or those whose disability impairs oral hygiene. Sealants on certain permanent molars are covered once every three years but require prior authorization for adults.
A complete X-ray series is allowed once every three years, and bitewing X-rays once every six months, though the two cannot overlap within six months of each other except in an emergency. Panoramic X-rays are also covered.4ForwardHealth. BadgerCare Medicaid Dental Codes
Fillings and Crowns
Amalgam and composite fillings are covered once per tooth every three years for permanent teeth. Crowns in porcelain, ceramic, or base metal are covered once every five years per tooth, with a limit of three crowns in any 12-month period before prior authorization becomes necessary.4ForwardHealth. BadgerCare Medicaid Dental Codes
Root Canals and Gum Treatment
Root canal therapy is covered once per lifetime per permanent tooth, excluding third molars. Molar root canals and treatment involving four or more teeth need prior authorization for adults. Periodontal scaling and root planing are covered once every three years per quadrant, and periodontal maintenance is generally allowed once per year. Both require prior authorization.4ForwardHealth. BadgerCare Medicaid Dental Codes
Dentures and Bridges
Complete and partial dentures are covered once every five years, with prior authorization and supporting X-rays required. Denture repairs do not need prior authorization, and relines are allowed once every three years.5ForwardHealth. BadgerCare Medicaid Prosthodontics and Maxillofacial Surgery Codes Fixed bridges with pontics and retainer crowns are also covered with prior authorization.
Extractions and Oral Surgery
Oral and maxillofacial surgery is limited to services tied to trauma, congenital conditions such as cleft palate, or the removal of teeth that are pathologic, painful, or non-restorable.6ForwardHealth. BadgerCare Medicaid Oral and Maxillofacial Surgery Surgical extractions outside emergencies or children’s orthodontic treatment are restricted. If a routine extraction unexpectedly becomes surgical, the provider must document the emergency.
What Children Get That Adults Don’t
Children’s benefits are broader, largely because of HealthCheck, Wisconsin’s version of the federal Early and Periodic Screening, Diagnosis, and Treatment program. HealthCheck opens the door to all medically necessary services for Medicaid-eligible children up to age 21.7SafetyWeb. HealthCheck
In practical terms, children get cleanings every six months rather than once a year, fluoride varnish up to four times per year for high-risk kids under five, and access to orthodontic treatment.4ForwardHealth. BadgerCare Medicaid Dental Codes8Wisconsin DHS. Oral Health Medicaid Orthodontic coverage is reserved for members under 21 with a severe and handicapping malocclusion, such as significant overjet, crossbite, cleft palate, or crowding of 10 millimeters or more, and it requires prior authorization with diagnostic records and a treatment plan.9ForwardHealth. BadgerCare Medicaid Orthodontics
What Wisconsin Medicaid Does Not Cover
State administrative code lists a set of dental services BadgerCare Plus will not pay for:
- Cosmetic procedures, including labial veneers and teeth whitening
- Surgical placement of dental implants (though implant maintenance and removal are covered)
- Non-surgical treatment of temporomandibular joint (TMJ) disorder
- Overlay dentures, overlay partials, and duplicate dentures
- Temporary crowns, occlusal guards, athletic mouthguards, behavior management, pulp cappings, and oral hygiene instruction billed as a standalone procedure
These exclusions are codified under Wis. Admin. Code ยง DHS 107.07(4).10ForwardHealth. BadgerCare Medicaid Non-Covered Dental Services There is one wrinkle on implants: UnitedHealthcare’s managed care plan in the six-county southeastern region lists some implant placement codes as covered, subject to prior authorization and lifetime limits.11UHC Dental. Wisconsin Provider Quick Reference Guide
Emergency Dental Care
Emergency dental services are covered without prior authorization and without copayment. ForwardHealth defines a dental emergency as immediate treatment for pain, acute infection, swelling, trismus, fever, or trauma.12ForwardHealth. BadgerCare Medicaid Emergency Dental Services Some frequency limits, such as those on X-rays and anesthesia, can be exceeded when the provider documents the nature of the emergency.4ForwardHealth. BadgerCare Medicaid Dental Codes
What You’ll Pay Out of Pocket
Most adults on BadgerCare Plus owe a small copayment for dental services, scaled to the cost of the procedure:
- Up to $10: $0.50
- $10.01 to $25: $1.00
- $25.01 to $50: $2.00
- Over $50: $3.00
Children under 19, American Indians and Alaska Natives, nursing home residents, and people receiving hospice care pay nothing. Emergency dental services are also copay-exempt. Providers cannot turn a member away for being unable to pay the copay, and combined premiums and copays cannot exceed 5% of a member’s monthly household income.13ForwardHealth. BadgerCare Medicaid Copayments
How You Receive Care Depends on Your County
In six southeastern counties (Milwaukee, Kenosha, Racine, Waukesha, Washington, and Ozaukee), dental benefits are delivered through managed care organizations. Members in those counties enroll in an HMO and must use dentists within that plan’s network.14Chorus Community Health Plans. Dental Benefit Plans
Managed care plans in the metro area include UnitedHealthcare Community Plan, Chorus Community Health Plans, and Molina Healthcare of Wisconsin (doing business as My Choice Wisconsin).1UHC. UnitedHealthcare Community Plan Wisconsin BadgerCare Plus15Molina Healthcare. Wisconsin Dental Provider Manual DentaQuest administers dental benefits for some plans, including Anthem Blue Cross Blue Shield.16DentaQuest. Wisconsin Medicaid Dental Coverage Anthem BCBS HMOs may set their own prior authorization rules, but those rules cannot leave a member with less coverage than the fee-for-service program provides.2ForwardHealth. SSI HMO Program UnitedHealthcare members have no copayment for dental services.
Everywhere else in the state, members use the fee-for-service system and can see any dentist who accepts a ForwardHealth card.14Chorus Community Health Plans. Dental Benefit Plans
Finding a Dentist Who Takes BadgerCare Plus
Members can search the Find Care tool on the ForwardHealth portal, filtering by “Dental” plus location and language.17ForwardHealth. ForwardHealth Provider Directory Search The Wisconsin Department of Health Services also keeps a searchable list of free and low-cost dental clinics, federally qualified health centers, dental schools, tribal health centers, and rural health clinics.18Wisconsin DHS. Find Dental Care If a search comes up empty, ForwardHealth Member Services can be reached at 800-362-3002, and the dental ombudsman at 800-947-9627, option 4.8Wisconsin DHS. Oral Health Medicaid
Expect the search to take some work. Only about 29 percent of Wisconsin dentists participate in Medicaid.19WPR. Health Care Advocates Say Dental Therapists Will Help Provider Shortage in Wisconsin In 2021, seven counties had no dentists filing Medicaid claims at all, and in 21 counties fewer than 40 percent of dentists did. At community clinics and free dental programs, wait times for new patients often run several months.20Capital Times. Why Is Dental Care So Hard to Get in Wisconsin Coverage on paper does not always translate quickly into an appointment, so starting the search early, and calling more than one office, is often necessary.