Indiana Medicaid dental coverage

Last verified: June 2026

Dental coverage for adults: HIP Plus vs. HIP Basic

Indiana's HIP waiver creates a two-tier structure that affects dental coverage directly. Under the Section 1115 waiver terms approved by CMS, HIP Plus includes dental benefits — coverage for preventive, basic restorative, and in some cases major services, delivered through the member's managed care organization. HIP Basic provides limited or no dental coverage for most adult services.

The specific dental benefits available through HIP Plus vary by health plan. Anthem, CareSource, MHS, and UnitedHealthcare each administer dental through their plan networks. Members should contact their health plan directly to confirm what dental services are covered, which dentists are in-network, and whether prior authorization is required for restorative work.

Members who are unsure which HIP tier they are on can check by calling the FSSA Member Services line at 800-457-4584 or logging into the FSSA Benefits Portal at fssabenefits.in.gov.

What HIP Plus dental typically covers

While exact benefits vary by plan and can change with contract renewals, HIP Plus dental benefits generally include:

• Preventive care — cleanings (prophylaxis), exams, and X-rays
• Basic restorative services — fillings for decayed teeth
• Tooth extractions
• Emergency dental treatment for pain or infection
• Some plans may cover additional services — verify with your plan

Indiana HIP Plus plans typically do not cover orthodontics for adults, cosmetic dental procedures, or implants. Major services like crowns and root canals may be covered with prior authorization on some plans but not others. Call your health plan's member services number to get a current list of covered dental services before scheduling an appointment.

Dental coverage for children: comprehensive EPSDT benefits

Children enrolled in Hoosier Healthwise (Indiana's Medicaid/CHIP program for children) receive comprehensive dental coverage under the federal EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) mandate. EPSDT requires states to cover all medically necessary dental services for Medicaid-enrolled children under age 21 — not just a list of approved services, but anything that is medically necessary.

• Preventive care: dental exams, cleanings, fluoride treatments, and sealants
• Diagnostic X-rays
• Fillings and restorative care
• Extractions
• Orthodontics when medically necessary
• Oral surgery
• Emergency dental treatment

Source: Federal EPSDT requirements (42 U.S.C. § 1396d(r)); Indiana Hoosier Healthwise program documentation. Contact your child's health plan for in-network dental provider lists in Indiana.

Finding a dentist who accepts Indiana Medicaid

Indiana Medicaid dental providers operate within each health plan's network. The FSSA member portal at in.gov/medicaid lists over 50,000 providers statewide. To find a dentist accepting Indiana Medicaid: log into the FSSA Benefits Portal, select your health plan, and use the provider directory. Alternatively, call your health plan's member services line and ask for a list of in-network dentists in your county.

Dental coverage in Medicaid: what to know

Medicaid dental coverage is not uniform across states. Federal law requires comprehensive dental care for children under 21 through Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). Adult dental is optional — states can offer emergency-only coverage, limited coverage, or a full dental benefit. Several states have reduced or eliminated adult dental during budget cuts, then restored it later.

The practical result: two people in different states with identical income and family circumstances can have very different dental coverage. Children's dental is the one reliable floor; adult coverage depends entirely on what Indiana has chosen to fund.

Children's dental coverage (under 21)

Under the EPSDT mandate — codified in 42 U.S.C. § 1396d(r) — Medicaid must cover all medically necessary dental services for enrollees under 21 in every state. This is one of the few areas where the federal floor for Medicaid is genuinely comprehensive: states cannot restrict children's dental coverage the way they can adult coverage.

EPSDT dental includes preventive care (cleanings, fluoride treatments, sealants), diagnostic X-rays, restorative work (fillings, crowns), extractions, orthodontia when medically necessary, and emergency dental care. The "medically necessary" standard is broad for children — if a dentist certifies that a service is needed for the child's health, Medicaid must cover it.

Children covered by Indiana Medicaid (Healthy Indiana Plan) or CHIP are entitled to this full EPSDT dental benefit regardless of what Indiana provides to adults.

Adult dental coverage (age 21 and older)

Adult Medicaid dental falls into three general tiers across states, though the specifics vary considerably:

Check the current Indiana Medicaid (Healthy Indiana Plan) benefit package to confirm which tier Indiana currently provides and whether a dental benefit cap applies.