Yes, Peach State Health Plan does cover dental care, but what you get depends on your age and program. Adults 21 and older receive a short list of free preventive and emergency services. Children under 21, whether enrolled through Medicaid or PeachCare for Kids, receive the broader preventive, restorative, and orthodontic coverage that federal law requires. New mothers get expanded dental benefits for 12 months after delivery.
What Adults Get
If you’re 21 or older, Peach State covers the following at no copay:
- Oral exams and cleanings, up to twice a year
- Bitewing x-rays
- Simple tooth removal
- Oral surgery (non-routine procedures require prior authorization)
- Over-the-counter dental hygiene supplies, including toothpaste, toothbrushes, floss, and pain relievers
You don’t need a referral for routine dental care. All covered services must be medically necessary, and some are subject to coverage limits or require a doctor’s order or prior approval.
What Children Get
Children enrolled through Medicaid or PeachCare for Kids receive full dental coverage under the federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. Through Peach State, that includes:
- Periodic check-ups, exams, cleanings, and bitewing x-rays
- Simple extractions and other restorative services
- Dental sealants and fluoride treatments
- Medically necessary orthodontic treatment, including braces for children ages 10 to 20 when a qualifying condition is present
Each child should have a Primary Care Dentist who acts as their Dental Home, handling routine care and referring out to specialists when needed. Non-routine care such as dental surgery requires the provider to request prior authorization from Peach State.
Postpartum Dental Coverage
If you’ve recently given birth, Peach State covers expanded postpartum dental care for up to 12 months after delivery. This benefit took effect July 1, 2024. To receive it, report your expected due date or delivery date through the Georgia Gateway portal or by calling 877-427-3224.
The 2024 Statewide Expansion and What It Means for Adults
Georgia used to limit adult Medicaid dental benefits to emergencies. That changed with the Fiscal Year 2025 Appropriations Act. A federal State Plan Amendment (SPA GA-24-0005) approved by the Centers for Medicare and Medicaid Services on August 8, 2024 made the expansion effective July 1, 2024. The approved categories cover diagnostic, preventive, restorative, periodontal, prosthodontic, orthodontic, endodontic, and emergency dental services, plus inpatient and outpatient oral surgery.
Peach State’s public benefits page and member materials still list only the narrower set of adult services described above. Fillings, crowns, root canals, dentures, and bridges don’t appear on the plan’s adult coverage list, even though the state expansion includes those categories. If you believe you should have access to a service covered under the expanded state benefit, call Peach State Member Services at 1-800-704-1484 and ask what’s currently available under your plan.
Finding a Dentist and Getting Approval
Peach State’s dental network is managed by Centene Dental Services, also known as Envolve Dental. You can find an in-network dentist on the plan’s website, through the number on the back of your member ID card, or by calling Envolve Dental at 1-844-464-5632. Routine appointments should be available within 21 calendar days, and urgent dental care within 48 hours.
Prior authorization for non-routine dental work goes through Envolve Dental rather than Peach State’s general authorization system. Providers can submit requests through pwp.envolvedental.com or by calling Envolve. You don’t need a referral for routine visits.
Peach State also pays for free transportation to and from dental appointments. Schedule the ride with your regional transportation provider at least three days in advance.
Costs
The dental services Peach State lists as covered carry no copay. Oral exams, cleanings, bitewing x-rays, and simple extractions are all free. The member handbook notes that small copayments may apply to certain services depending on whether you’re enrolled in Medicaid or PeachCare for Kids, but you can’t be denied a covered service for inability to pay.
If a Dental Service Is Denied
You have 60 calendar days from the denial notice to file an appeal. You can appeal by phone at 1-800-704-1484 or in writing to the Grievance and Appeals Coordinator at Peach State’s Atlanta office. The plan sends an acknowledgment within 10 calendar days and usually issues a decision within 30. If waiting could jeopardize your health, you can request an expedited appeal, decided within 72 hours. If you want your benefits to continue during the appeal, file within 10 calendar days of the denial, though you may owe the cost if the final decision goes against you.
If the plan upholds the denial, Medicaid members can request a State Fair Hearing within 120 calendar days. PeachCare for Kids members can request review by a Formal Grievance Committee within 30 calendar days.
Ambetter Marketplace Plans Are Different
If your coverage is an Ambetter plan from the Georgia Access exchange rather than Medicaid or PeachCare for Kids, dental is handled separately. Ambetter offers dental as a supplemental add-on covering preventive, diagnostic, and basic care, with pediatric dental options. Not every Ambetter plan includes it, and the add-on carries its own premium. Check your plan details through your member account or at georgiaaccess.gov before assuming dental is included.