Paying for Oral Care as a Nursing Home Resident

The Incurred Medical Expense: An Option to Assist with Paying for Oral Care

People in nursing homes may have trouble receiving adequate dental care because of unique oral care challenges, such as the time required for adding a daily oral hygiene routine and the difficult clinical situations that arise more frequently with older patients such as diabetes.

High costs also present an obstacle because, although most people have had dental insurance through their employers, this coverage often disappears upon retirement. Medicare only pays for dental care in rare instances and adult Medicaid only covers dental treatments in a handful of U.S. states, and sometimes may have a low reimbursement rate.

As a result, many nursing home residents often cannot afford the dental care they need.

Oral health problems have a significant impact on mental and physical health, including on self-esteem and overall quality of life. This is why it is so critical for every person to have access to oral care. One option to help nursing home residents afford care is the Incurred Medical Expense, or IME.

A Possible Solution: Incurred Medical Expense

The Incurred Medical Expense (IME) is a federal law that allows qualified older adults living in nursing homes to pay for dental care. IME may also help pay for other healthcare services such as eyeglasses or hearing aids.

How does it work?

Residents who are eligible for Medicaid often use their Social Security checks (or other income) to pay for monthly nursing home costs. The IME can change the resident’s monthly income to pay for dental services instead of the nursing home. Nursing home expenses get reimbursed later, when a Medicaid case-worker increases the amount that Medicaid pays to the nursing home on behalf of that resident that month.

What can IME cover?

IME covers dental services that are medically necessary and not covered by your state’s adult Medicaid program (or by any third-party insurance coverage). To use IME, there is cooperation needed among the nursing home staff, Medicaid case workers, patients, families, and the dentist providing care. However, IME processes differ by state, so it’s best to contact your state Medicaid office for details about your state’s specific policies.

About the Author

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

The information on this article is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Tooth Wisdom® and Oral Health America do not recommend or endorse any specific dentists, products, procedures, opinions, or other information mentioned. See full Terms & Conditions.

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