Yes. Wisconsin Medicaid does cover dental care through BadgerCare Plus, for both children and adults. Adults get a defined set of preventive, restorative, endodontic, periodontal, prosthetic, and emergency services, almost all of them subject to frequency limits and many requiring prior authorization. Children get broader benefits, including orthodontics in severe cases. A short list of services, including cosmetic work and most dental implants, is excluded outright.1ForwardHealth. BadgerCare Medicaid Non-Covered Dental Services
What Adults Are Covered For
Adults 21 and older on BadgerCare Plus can use the following, with the frequency limits that matter most in planning a visit.
Cleanings, Exams, and X-Rays
One dental cleaning per year. Members who are permanently disabled may receive up to four cleanings in a 12-month period. Topical fluoride is covered once per year, with the same higher frequency for members at high caries risk or with a disability that impairs oral hygiene.2ForwardHealth. BadgerCare Medicaid Dental Codes
A complete X-ray series is allowed once every three years, bitewings every six months, and panoramic X-rays are also covered. The series and bitewings can’t overlap within six months of each other except in an emergency. Sealants on certain permanent molars are covered once every three years but need prior authorization for adults.2ForwardHealth. BadgerCare Medicaid Dental Codes
Fillings and Crowns
Amalgam or composite fillings are covered once per tooth every three years on permanent teeth. Crowns (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 kicks in.2ForwardHealth. BadgerCare Medicaid Dental Codes
Root Canals and Gum Treatment
Root canal therapy is covered once per lifetime per permanent tooth, excluding wisdom teeth. Molar root canals and treatment involving four or more teeth require prior authorization for adults. Periodontal scaling and root planing are covered once every three years per quadrant, and periodontal maintenance is typically allowed once per year; both need prior authorization.2ForwardHealth. BadgerCare Medicaid Dental Codes
Dentures and Bridges
Complete and partial dentures are covered once every five years, with prior authorization and supporting documentation including X-rays. A six-week healing period after the last extraction is required before impressions, though a provider can request an exception for medical necessity. Denture repairs don’t need prior authorization, and relines are allowed once every three years. Fixed bridges with pontics and retainer crowns are also covered with prior authorization.3ForwardHealth. BadgerCare Medicaid Prosthodontics and Maxillofacial Surgery Codes
Extractions and Oral Surgery
Oral and maxillofacial surgery is limited to services related to trauma, congenital malformations such as cleft palate, or the removal of teeth that are pathologic, painful, or non-restorable. Surgical extractions outside an emergency (or outside orthodontic treatment for children) are restricted. If a routine extraction turns surgical during the procedure, the provider has to document it as an emergency.4ForwardHealth. BadgerCare Medicaid Oral and Maxillofacial Surgery
What Wisconsin Medicaid Does Not Cover
State administrative code lists specific exclusions. The ones most likely to catch members by surprise:
- Cosmetic procedures, including labial veneers and teeth whitening.
- Dental implant placement under the fee-for-service program. Implant maintenance and removal are covered.
- Non-surgical TMJ treatment.
- Overlay dentures, overlay partials, and duplicate dentures.
- Temporary crowns, occlusal guards, athletic mouthguards, behavior management, pulp cappings, and standalone oral hygiene instruction.
These exclusions sit at Wis. Admin. Code § DHS 107.07(4).1ForwardHealth. BadgerCare Medicaid Non-Covered Dental Services One narrow exception on implants: UnitedHealthcare’s managed care plan in the six-county Milwaukee-area region does list some implant placement codes as covered benefits, subject to prior authorization and lifetime limits.5UHC Dental. Wisconsin Provider Quick Reference Guide
What Children Get That Adults Don’t
Benefits for members under 21 are broader because of HealthCheck, Wisconsin’s version of the federal EPSDT program, which opens up all medically necessary services for Medicaid-eligible children.6SafetyWeb. HealthCheck2ForwardHealth. BadgerCare Medicaid Dental Codes7Wisconsin DHS. Oral Health Medicaid
Orthodontic coverage isn’t open-ended. It’s limited to members under 21 with a severe and handicapping malocclusion, such as significant overjet, crossbite, cleft palate, or severe crowding of 10 millimeters or more, and it requires prior authorization with diagnostic records and a treatment plan.8ForwardHealth. BadgerCare Medicaid Orthodontics
Emergency Dental Care
Emergency dental services don’t require prior authorization and have no copayment. ForwardHealth defines a dental emergency as immediate treatment needed to relieve pain, acute infection, swelling, trismus, fever, or trauma. Palliative treatment for pain relief is reimbursed up to $62.50 per visit. Some frequency limits (on X-rays, anesthesia, and similar) can be exceeded in an emergency, but the provider has to document what made it one.9ForwardHealth. BadgerCare Medicaid Emergency Dental Services
What You’ll Pay
Most adults on BadgerCare Plus pay a small copay per dental service, scaled to the cost of the procedure:
- Service cost up to $10: $0.50
- $10.01 to $25: $1.00
- $25.01 to $50: $2.00
- Over $50: $3.00
Several groups are exempt from copays entirely: children under 19, American Indians and Alaska Natives, nursing home residents, and people receiving hospice care. Emergency dental services are also copay-exempt. A provider cannot refuse to treat you because you can’t pay the copay at the visit, and your total premiums plus copays are capped at 5% of your monthly household income.10ForwardHealth. BadgerCare Medicaid Copayments Members enrolled in UnitedHealthcare’s managed care plan pay no copay for dental services.11UHC. UnitedHealthcare Community Plan Wisconsin BadgerCare Plus
How You Use the Benefit Depends on Your County
In six southeastern counties (Milwaukee, Kenosha, Racine, Waukesha, Washington, and Ozaukee), dental benefits are delivered through a managed care organization. If you live there, you’re enrolled in an HMO and have to use dentists in that plan’s network.12Chorus Community Health Plans. Dental Benefit Plans11UHC. UnitedHealthcare Community Plan Wisconsin BadgerCare Plus13Molina Healthcare. Wisconsin Dental Provider Manual DentaQuest administers dental benefits for some of them, including Anthem Blue Cross Blue Shield.14DentaQuest. Wisconsin Medicaid Dental Coverage Anthem BCBS HMOs can set their own prior authorization rules, but they can’t cover less than the fee-for-service program does.15ForwardHealth. SSI HMO Program
Everywhere else in Wisconsin, you’re on fee-for-service and can see any dentist who accepts a ForwardHealth card.12Chorus Community Health Plans. Dental Benefit Plans
Finding a Dentist Who Accepts BadgerCare
Use the Find Care tool on the ForwardHealth portal and filter by “Dental” to search by location, language, and other criteria.16ForwardHealth. ForwardHealth Provider Directory Search The Wisconsin Department of Health Services also keeps a searchable list of free and low-cost dental clinics, including federally qualified health centers, dental schools, tribal health centers, and rural health clinics.17Wisconsin DHS. Find Dental Care If you can’t find a provider online, call ForwardHealth Member Services at 800-362-3002, or the dental ombudsman at 800-947-9627, option 4.7Wisconsin DHS. Oral Health Medicaid
Coverage Is One Thing, Access Is Another
Having the benefit and finding a dentist willing to use it are not the same problem. Only about 29% of Wisconsin dentists participate in Medicaid.18WPR. 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% did. Fewer than 10% of Wisconsinites on Medicaid received preventive dental services in 2021–2022, and wait times at community clinics and free dental programs often stretch to several months.19Capital Times. Why Is Dental Care So Hard to Get in Wisconsin If you need care, start looking early, and keep the ombudsman number handy if the directory doesn’t produce a usable appointment.