Orthodontic care, such as braces, can be a significant expense for families. Many parents in California wonder if Medicaid will cover the cost of braces for their children. The answer is complex and involves specific criteria and evaluations. In this blog post, we’ll explain how Medicaid determines coverage for braces in California, including the point system used and the automatic qualifiers for coverage.
The Short Answer
Yes — Medi-Cal Dental (Denti-Cal) covers braces for children and teens under 21 when there is a medical need. Medi-Cal approves full orthodontic treatment when a child has a “handicapping malocclusion,” meaning the bite is severe enough to affect their health, speech, chewing, or self-esteem. Coverage is based on a scoring system called the HLD Index, not on cosmetic preference.
If your child qualifies, the braces cost you $0 out of pocket. If they don’t qualify, we offer braces starting at just $87/month with $0 down. At Textbook Orthodontics, we accept Medi-Cal Dental directly, and our team handles the paperwork for you.
Understanding Medicaid Coverage for Braces
Medicaid, known as Medi-Cal in California, provides health coverage for low-income individuals and families. While Medi-Cal covers many health-related services, orthodontic care like braces is not always guaranteed. Coverage is determined based on the severity of the dental issues and specific eligibility criteria.
The Point System
Medi-Cal uses a point system to assess the necessity of orthodontic treatment. This system evaluates the severity of dental conditions and assigns points based on specific criteria. The higher the points, the more likely it is that the treatment will be covered. However, only a small percentage of patients meet the point threshold required for coverage.
Who qualifies? To get braces covered by Medi-Cal in California, your child must:
Be under 21 years old
Have active Medi-Cal Dental (Denti-Cal) coverage
Score 26 points or higher on the HLD Index, or have one of the automatic qualifiers listed below
Criteria for the Point System
Points are assigned based on various dental issues, such as:
Severe crowding of teeth
Deep overbite
Underbite
Open bite
Crossbite
Large gaps between teeth
Each condition contributes to the overall score, and a cumulative score above a certain threshold is needed to qualify for coverage.
What Is the HLD Score?
The HLD (Handicapping Labio-lingual Deviation) Index is the points-based system the State of California uses to decide who needs braces medically. An orthodontist measures things like overjet, overbite, crowding, crossbite, and open bite, and each problem earns points. If the total reaches 26 or more, Medi-Cal will approve treatment.
At your free consultation, we score your child’s HLD on the spot and tell you honestly whether they’re likely to qualify — before any paperwork is submitted.
Automatic Qualifiers for Coverage
Certain severe dental conditions automatically qualify for Medi-Cal coverage without needing to meet the point threshold. These include:
1. Cleft Lip and Palate
Children born with a cleft lip and palate require extensive orthodontic treatment as part of their overall care. This condition is considered a medical necessity, and treatment is usually covered by Medi-Cal.
2. Severe Malocclusion
Severe malocclusions, which are significant misalignments of the teeth that affect normal functions like chewing, speaking, and breathing, are typically covered as they are deemed medically necessary.
3. Impacted Teeth
When teeth are blocked from emerging naturally, they are considered impacted. This condition often requires surgical intervention followed by orthodontic treatment, which is usually covered by Medi-Cal.
4. Jaw Discrepancies
Significant discrepancies in jaw size or alignment that cause functional problems can also qualify for coverage. These issues often require a combination of orthodontic treatment and surgery.
5. Injury-Related Dental Issues
If dental issues result from an injury, orthodontic treatment may be covered as part of the overall medical care to restore function and appearance.
Steps to Determine Coverage
Consult with Your Orthodontist: Start by consulting with your orthodontist. They can perform an initial assessment and provide a treatment plan.
Submit a Pre-Authorization Request: Your orthodontist will submit a request to Medi-Cal, including the necessary documentation and evidence of medical necessity.
Review the Medi-Cal Guidelines: Carefully review Medi-Cal guidelines to understand what is covered and what isn’t. Look for specific clauses related to orthodontic care.
Appeal if Necessary: If your request is denied, you can appeal the decision. Sometimes additional documentation or a second opinion can help in getting coverage approved.
How Long Does Medi-Cal Approval Take?
Once we submit the Treatment Authorization Request (TAR) with X-rays, photos, and the HLD score:
Typical approval: 2 to 6 weeks
Once approved: We schedule braces placement, usually within 2 weeks
Total treatment time: Most kids are in braces for 18 to 24 months
We’ve been doing Medi-Cal orthodontics for years, so we know exactly how the state likes the paperwork submitted — which means fewer denials and faster approvals.
What If My Child Doesn’t Qualify?
Not every child qualifies for Medi-Cal braces, but every child deserves a confident smile. If the HLD score falls short, we offer:
Metal braces from $87/month with $0 down
Clear/ceramic braces for a less visible option
Invisalign Teen from $127/month
In-house financing — no credit check, no hidden fees
Flexible monthly plans customized to your family’s budget
See all our braces options → or view financing details →
Where We Serve Medi-Cal Patients
We accept Medi-Cal Dental at all four Textbook Orthodontics offices:
Los Angeles: (213) 933-6370
Panorama City: (818) 510-3440
Hawthorne: (310) 751-3098
Whittier: (562) 693-8202
Hablamos Español en todas nuestras oficinas.
Conclusion
While Medi-Cal coverage for braces in California is not guaranteed for every child, understanding the point system and the conditions that automatically qualify for coverage can help you navigate the process. Always consult with your orthodontist and review Medi-Cal guidelines to determine the best course of action. At Textbook Orthodontics, we are here to assist you in understanding your options and ensuring your child receives the best possible care. Contact us for more information or to schedule a consultation.
