In Arizona, Medicaid will cover all medically necessary treatment for children under 19, including dental crowns.
In this blog post, we discuss how Medicaid pays for dental treatment for Arizona residents, including dental crowns. Specifically, we go over:
- How Arizona partners with federal Medicaid to provide Medicaid coverage to children
- Eligibility requirements to have Medicaid benefits pay for dental crowns
- Alternatives to Medicaid for low-income parents whose children need dental crowns
At the Kids Dental Office of Phoenix, our pediatric dentists accept Medicaid payment for dental services. To learn more about how Medicaid may be able to help you afford dental treatment for your child, or to schedule an appointment with us, call us at (602) 903-4894.
How Does Arizona Partner With Medicaid?
Medicaid does not pay for medical treatment directly.
Instead, each state partners with Medicaid to manage and provide Medicaid services to eligible households. In Arizona, the Medicaid partner program is the Arizona Health Care Cost Containment System (AHCCCS).
AHCCCS, in turn, partners with Arizona insurance companies to provide Medicaid coverage to eligible families.
AHCCCS will pay all costs of children’s medically necessary treatment through age 18. This includes medically necessary dental treatment. Children aged 19 and older are eligible only for emergency medical treatment.
Under AHCCCS Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, dental crowns are covered when necessary for your child’s oral health, playing a vital role in preventive care.
How Can Your Child Be Eligible for Medicaid Coverage for Dental Crowns?
Medicaid has specific eligibility requirements before your child can have crowns paid for through AHCCCS. Eligibility begins with meeting basic requirements:
- U.S. citizenship or qualified non-residents of the United States
- Arizona residency
- A Social Security Number (with a few exceptions)
In addition to these basic requirements, AHCCCS and Medicaid apply household income restrictions for eligibility. These restrictions are based on the federal poverty level, the number of members in the household, and the child’s age:
| Child’s Age | Medicaid Household Monthly Income Restriction(Based on Household Size) |
| Under 1 year of age | 1: $1,9182: $2,5913: $3,2654: $3,939 |
| Age 1 through 5 | 1: $1,8392: $2,4863: $3,1324: $3,778 |
| Age 6 through 18 | 1: $1,7352: $2,3453: $2,9544: $3,564 |
Add $674 for each additional household member more than four.
Do Other Low-Income Payment Options Besides Medicaid Exist for Pediatric Dental Crowns?
If your household income is too much to qualify for Medicaid through AHCCCS, but is still low income, then you may be eligible for KidsCare in Arizona.
KidsCare is a partnership program between the federal government and Arizona. Instead of Medicaid, the federal partnership is based on the Children’s Health Insurance Program (CHIP).
Aside from household income eligibility requirements, the main difference between KidsCare and AHCCCS for children less than 19 years old is that KidsCare insurance coverage carries a monthly premium requirement of $10 to $50 for one child, and $15 to $70 for more than one child, with the exact premium payment based on the household size.
Otherwise, KidsCare pays for pediatric dentistry in the same way that AHCCCS does.
In addition to federally funded dental healthcare programs like AHCCCS and KidsCare, other options may be available if your household cannot afford to pay out of pocket for your child’s dental crowns. Some examples include:
- Some dental school clinics may provide comprehensive care for kids for reduced fees.
- Federally qualified health centers may offer children’s dental services based on sliding fee scales.
- Charity and community dental clinics offer free or low-cost dental services for uninsured children.
What are Dental Crowns?
A dental crown is a tooth-shaped cap that goes over a child’s tooth that is decayed by cavities or infection, or otherwise damaged to the point where a traditional filling will not work.
Crowns are best used for your child’s permanent teeth. A crown goes over the tooth above the gum line, creating a shell that protects it from bacteria, plaque, and infection in the child’s mouth.
Crowns for children serve many treatment purposes:
- They can repair a cracked or broken tooth.
- They can cover a tooth after your child undergoes root canal surgery.
- They can cover a dental implant or support a dental bridge.
- They can stop the spread of decay in damaged teeth.
- Tooth-colored crowns can be used to improve the appearance of discolored or misshapen teeth, matching the color of the affected tooth with its neighboring teeth (this kind of cosmetic treatment may not be considered medically necessary for Medicaid purposes).
Crowns can be made from a variety of materials, including:
- Stainless steel crowns, which are highly durable
- Zirconia crowns, suitable for all teeth due to their durable nature
- Other metal crowns, including nickel, gold, or palladium, often used for molars
- Crowns made from resins or acrylics, often used for temporary crowns
- Ceramic or porcelain crowns, often useful for children with metal allergies and also used for front teeth
As with other dental treatments, your child may experience some discomfort immediately after crown installation, but this will normally pass within a few days without the need for further treatment.
As part of your child’s dental treatment plan, crowns usually last from five to 15 years with proper care, including regular brushing and flossing.
Call the Kids Dental Office of Phoenix to Learn About Medicaid and Crowns
Dental crowns can be a great option for teeth that are severely damaged by tooth decay, cracks, or fractures. They can prevent further decay and, in some cases, avoid the need for a tooth extraction. Crowns can also make your child’s smile more appealing by preserving a damaged tooth rather than removing it.
At the Kids Dental Office of Phoenix, we provide children’s dental care services for households of all income levels, including through AHCCCS and KidsCare. If your child needs a pediatric dental crown or any other dental treatment, call us at (602) 903-4894 or use our contact form to schedule an appointment.
In addition to Medicaid through AHCCCS and CHIP through KidsCare, we accept many other insurance plans and can help you seek alternative financing if needed.