Does Medicaid Pay For Braces?

Medicaid is the largest medical cover programs for families in the United States. Children are the largest beneficiaries of this program. It said that out of every ten kids, three of them are under Medicaid cover. The program has seen some expansions over the years to cater to more than just disabled persons.

Children from low-income families can now have the same medical cover as those with private insurance. Expectant women and the elderly are also other demographics that can enroll with this type of cover. There are requirements one must meet to be able to qualify for Medicaid cover. One question people ask is; does Medicaid pay for braces?

Dental Services Provided

The type of coverage offered under Medicaid will vary from state to state. The scope of services one receives will depend on where they live. There are mandatory benefits that come with the program and some optional ones that are determined by the coverage one is on. One question that is common is if Medicaid pays for braces. To answer that, one must first understand what dental services are available under Medicaid cover.

Dental services are considered essential, especially for children. It is for this reason that children under Medicaid cover receive dental services as part of their primary benefits. Whether or not the services are provided to adults will depend on the regulations of a particular state.

The medical necessity of a patient is what will determine the dental services they will receive. However, some minimal standards must be met when receiving dental care, and these include:

  • Teeth Restoration
  • Pain and Infection Relief
  • Dental Health Maintenance

The benefits that children under Medicaid receive are implemented through Early and Periodic, Screening, Diagnostic and Treatment (EPSDT). Children must receive dental screening because it is imperative for an individual’s health.

Situations that Qualify

Any dental health issues that come up during a checkup can be treated under Medicaid cover if a doctor deems it medically necessary. That means Medicaid will cover braces if a dentist decides they are important. It does not matter if the service is under Medicaid cover or not.

Under the program, the dental services necessary for the promotion of oral health, restoration of oral structure for the enhancement of health functions and prevention of diseases must be provided to enrollees.

Another thing that will tell if Medicaid pays for braces is prevalent. For instance, if a problem affects a patient’s lifestyle, this is something that the dentist will determine. What this means is that a doctor will look at how a condition is interfering with an individual’s standards of living. If someone is not able to open their mouth properly, chew or talk, then braces become a necessary treatment. A patient with a cleft palate or lip will also be eligible for Medicaid payment for their braces.

Medicaid does cover for braces if an individual wouldn’t be able to function properly without them. Braces for cosmetic purposes will usually not be covered under the program. It is crucial to point out that in some states, it may be quite complicated to use the program to pay for braces.

One must also find dentists that accept Medicaid cover. Some states have taken measures to make it less complex for people to get the dental services they need with Medicaid. One can also find more information from their state office if they have some concerns. The information above provides answers to the question; does Medicaid cover braces?