Nursing Home Residents: Paying for Oral Care

Sarah Dirks | 02.01.2013

Nursing Home Residents: Paying for Oral Care

Often people in nursing homes do not receive adequate mouth care. There are many challenges to providing dental services in a nursing home.  This includes poor daily routines for keeping the mouth clean and difficult clinical situations not typically seen in most dental practice settings. 

Dental insurance is often lost when people retire.  Medicare only pays for dental care in rare instances. Many nursing home residents cannot afford to get their needed dental care.  Oral health problems affect self-esteem, can contribute to the demise of overall health, and decrease quality of life.  Dentists may not provide care to nursing home residents with Medicaid if the state has a low compensation rate.

What is Incurred Medical Expense?

Incurred Medical Expense (IME) allows older adults living in a nursing home who qualify for Medicaid to pay for dental care.  The IME process is federal law. IME could pay for other medically necessary healthcare services such as eyeglasses or hearing aids.

How does it work?

Residents who are eligible for Medicaid use their Social Security checks and other income to pay their monthly nursing home costs.  When the IME option processes, the resident’s monthly income pays for dental services instead of the nursing home. The Medicaid case worker will increase the amount Medicaid pays that month to the nursing home on behalf of that older adult. The nursing home still receives full payment. 

IME covers dental services that are medically necessary and not covered by your state’s adult Medicaid program (or by any third party payer.)  To use IME, the nursing home staff, Medicaid case workers, patients, families, and providing dentist must cooperate. Please note that the IME process differs state by state. Contact your state Medicaid dental office for details of your state’s policies.

Sarah Dirks, DDS
Adjunct Faculty - University of Texas Health Science Center San Antonio
CEO - Geriatric Dental Group of South Texas, PA
Association of State & Territorial Dental Directors - Healthy Aging Committee
Texas Oral Health Committee
Special Care Dentistry--Geriatrics