Yes. Washington state’s Medicaid program, Apple Health, covers dental care for both adults and children, and enrollees pay nothing out of pocket for covered services — no copays, no deductibles, no premiums. The state pays dentists directly through a fee-for-service model rather than routing claims through a managed care plan.1Washington State Dental Association. Dental Medicaid What the benefit actually pays for depends on your age, and a few categories of work that people often expect to be covered are not.
What Adults Get
If you are 21 or older, Apple Health covers a defined list of dental services:
- Diagnostic care, including exams and X-rays
- Preventive care, including cleanings and fluoride
- Fillings
- Root canals on front (anterior) teeth only
- Deep cleanings and periodontal maintenance
- Complete and partial dentures
- Extractions and other oral surgery
- Sedation services, including nitrous oxide and general anesthesia2Washington State Health Care Authority. Apple Health Covered Dental Services
Some common procedures are explicitly excluded for adults: bridges, porcelain crowns, orthodontics, and dental implants.2Washington State Health Care Authority. Apple Health Covered Dental Services The anterior-only limit on root canals matters in practice: a molar that needs a root canal falls outside standard adult coverage. Immediate dentures, the kind made and placed the same day teeth come out, are also non-covered.3Washington State Health Care Authority. Apple Health Dental Providers Newsletter
What Children Get
Children age 20 and younger have broader coverage because of a federal Medicaid rule called Early and Periodic Screening, Diagnosis, and Treatment. EPSDT requires any medically necessary dental service to be covered for a child, even services that are not in the state’s standard benefit package. At minimum, the coverage must include relief of pain and infection, restoration of teeth, and maintenance of dental health.4Medicaid.gov. Dental Care
In practice, that means services excluded for adults — bridges or porcelain crowns, for example — can be approved for a child when a dentist documents medical necessity and gets prior authorization. Orthodontics are covered for children with a cleft palate or other serious dental conditions, also with prior authorization.5DentistLink. Apple Health Medicaid Covers Dental Care If a prior authorization request is denied, a family can discuss alternative treatments with the dentist or pay out of pocket after signing a waiver, which the provider keeps for six years.6Washington State Health Care Authority. EPSDT Dental Services
Frequency Limits
Apple Health does not set an annual dollar cap on dental benefits, but individual services have frequency limits. Routine exams and cleanings are generally covered every six months. X-rays are typically limited to once per year, with full-mouth series on longer intervals. Certain medications given during dental visits are capped at two in a 12-month period.7Washington State Health Care Authority. Dental-Related Services Billing Guide
Two pathways exist when you need more than the limits allow. A limitation extension asks the state to approve a service that has hit its frequency cap. An exception to rule asks for approval of something that is not ordinarily covered.7Washington State Health Care Authority. Dental-Related Services Billing Guide Your dentist submits either request.
Enhanced Benefits for Specific Groups
Several populations get dental services more often than the standard schedule.
Adults with diabetes qualify for up to four periodontal maintenance visits in a 12-month period, a benefit the legislature funded in 2023 and that took effect statewide on January 1, 2024.8Arcora Foundation. Medicaid Facts and Figures
Clients of the Developmental Disabilities Administration receive oral exams, cleanings, and fluoride treatments every four months instead of every six. Sealants are available at any age rather than only through age 20, with replacement every two years instead of three.9Informing Families. Enhanced Dental and Medical Benefits DDA clients are also exempt from the prior authorization requirement for non-emergency dental work performed in a hospital or surgical center.10Washington State Legislature. WAC 182-535-1079
Residents of skilled nursing facilities and alternate living facilities receive a cleaning every six months and fluoride twice in a 12-month period, with at least 170 days between applications.11Cornell Law Institute. WAC 182-535-1082
Pregnant enrollees get dental coverage as part of Apple Health for Pregnancy, and that coverage continues for a year after the pregnancy ends.12Help Me Grow WA. Health Insurance
ABCD for Young Children
Washington runs a separate program called Access to Baby and Child Dentistry for Medicaid-eligible children from birth through age five. ABCD matches young children with dentists who have completed specific training through the University of Washington Department of Pediatric Dentistry or a local ABCD trainer, and those dentists receive enhanced reimbursement for oral evaluations, family education, fluoride varnish, and restorative care.13Washington State Health Care Authority. ABCD and MouthMatters Billing GuideABCD Program Best Practice Children ages six through twelve on the DDA waiver can continue to access ABCD providers through an extension called MouthMatters. The program started in Spokane in the mid-1990s and now reaches more than half of eligible lower-income children from birth to age six, roughly 178,000 kids statewide.14ABCD Dental. About ABCD
Who Qualifies and How to Apply
Dental coverage comes automatically with Apple Health enrollment. Income thresholds are:
- Adults: up to 138% of the federal poverty level
- Pregnant individuals: up to 198% of the federal poverty level, with coverage continuing 12 months after birth
- Children with no premium: up to 215% of the federal poverty level
- Children’s Health Insurance Program with premiums: up to 317% of the federal poverty level
Most people apply through Washington Healthplanfinder. Those who are aged, blind, or disabled apply through the Washington Connection website or a local DSHS Community Services Office. You can also start an application by calling 1-877-501-2233.15healthinsurance.org. Washington Medicaid A plastic ProviderOne services card arrives roughly seven to ten days after enrollment, and you bring it to every dental appointment so the office can verify coverage.5DentistLink. Apple Health Medicaid Covers Dental Care
Finding a Dentist Who Accepts It
This is often the hardest part, particularly outside the state’s major metro areas. As of 2015, only about 28% of Washington dentists enrolled in Medicaid were accepting new patients, and in 2016 only about 22% of Medicaid-eligible adults and 56% of eligible children actually received dental services. Rural counties have fewer dentists per resident than urban ones.16University of Washington. Washington State Oral Health Workforce
Two tools help. The ProviderOne directory lets you search for participating dentists online. DentistLink is a free referral service: call or text 844-888-5465 on weekdays, or submit a request online, and a specialist will connect you with local dentists who accept Apple Health.5DentistLink. Apple Health Medicaid Covers Dental Care
2025 Rate Cuts May Affect Access
The benefit itself has not changed, but what the state pays dentists has. Governor Bob Ferguson signed Engrossed Substitute Senate Bill 5167 on May 20, 2025, cutting dental reimbursement rates effective July 1, 2025. For adults, the previous “up to 100%” rate increase over 2019 levels was reduced to “up to 50%.” For children, lawmakers removed half of the increases from the 2022 supplemental budget. Rates for the ABCD program and the orthodontic program were not cut.17Washington State Dental Association. Update on Adult and Pediatric Medicaid Reimbursement18Washington State Health Care Authority. Dental Rate Reductions
The Washington State Dental Association opposed the cuts, said they would “compromise the health and well-being of some of our state’s most vulnerable children and adult patients,” and submitted a formal veto request to the governor.17Washington State Dental Association. Update on Adult and Pediatric Medicaid Reimbursement By September 2025, the Health Care Authority had started tracking providers who were leaving Medicaid or limiting their Medicaid caseload in response.19Washington State Health Care Authority. Dental Providers Newsletter If a dentist who used to take Apple Health has stopped, this is why, and DentistLink is the most direct way to find one who still does.