Medicaid covers braces for children and teens under 21 in every state, but only when the orthodontic problem is severe enough to qualify as medically necessary. Adults have far fewer options, with most states excluding orthodontic coverage entirely for anyone over 21. Where you actually go to get braces depends on your state’s Medicaid dental plan and which orthodontists in your area accept it.
How to Find an Orthodontist That Takes Medicaid
The fastest way to find a provider is the federal Dentist Locator at InsureKidsNow.gov. You select your state, choose your child’s specific Medicaid dental plan from a dropdown menu, and enter your zip code. The tool lets you filter by specialty, including “Orthodontics and Dentofacial Orthopedics,” so you can skip general dentists and go straight to orthodontists who are confirmed to accept your coverage.
You can also call the number on your Medicaid card and ask for a list of in-network orthodontists. Many states contract with a dental managed care company (like DentaQuest, MCNA, or Envolve) that maintains its own provider directory online. If you’re enrolled in one of these plans, that directory will be more accurate than a general search.
Be prepared for a limited selection. Orthodontists who accept Medicaid are less common than general dentists who do, especially in rural areas. You may need to travel to a nearby city or get on a waiting list. Dental schools and university orthodontic clinics are another option worth checking. They often accept Medicaid patients and charge lower rates, with treatment supervised by licensed faculty.
Who Qualifies: Children vs. Adults
Federal law requires every state to provide comprehensive health services, including dental care, to Medicaid-enrolled children under 21. This mandate, known as EPSDT (Early and Periodic Screening, Diagnostic, and Treatment), means states must cover orthodontic treatment when a screening identifies a need for it, even if braces aren’t listed as a standard benefit in the state plan. For children under 18, these services come at no cost to the family.
For adults 21 and older, the picture is very different. States have complete flexibility to decide what dental benefits they offer adults, and there are no federal minimum requirements. Most states that do provide adult dental coverage explicitly exclude orthodontics. New York, for example, covers a wide range of adult dental services but specifically lists “No orthodontia.” Washington and Ohio follow the same pattern. Even states with generous adult dental benefits typically draw the line at braces.
The rare exceptions for adults usually involve severe cases tied to trauma, surgery, or congenital conditions like cleft palate. If you’re an adult on Medicaid who believes your situation is medically necessary, contact your state Medicaid office directly to ask about exceptions.
What “Medically Necessary” Means for Braces
Medicaid does not cover braces for cosmetic reasons, even for children. Your child’s orthodontic problem has to meet a clinical threshold that shows it’s affecting normal oral function, not just appearance. States use scoring systems and specific qualifying conditions to make this determination.
Certain conditions qualify automatically in most states. These include:
- Cleft palate or significant craniofacial anomalies
- Severe overbite (overjet exceeding 7 mm), where the upper front teeth protrude far beyond the lower teeth
- Deep overbite with tissue contact, where the lower front teeth are pressing into the gum tissue behind the upper teeth
- Crossbite involving multiple teeth, where upper and lower teeth don’t align properly and are causing soft tissue damage
- Impacted permanent canine teeth requiring surgical exposure
If your child’s condition doesn’t fall into one of those categories, many states use a scoring tool called the HLD (Handicapping Labio-Lingual Deviation) index. This measures how far teeth and jaws deviate from normal alignment and assigns a point value. In New Mexico, for instance, a score of 26 or higher meets the threshold. Other states set their own cutoff numbers, but the principle is the same: the misalignment has to be severe enough to constitute a functional problem.
Children who don’t meet the automatic qualifiers or the point threshold can sometimes still qualify if they have a documented medical condition or speech pathology that isn’t responding to other treatment and requires orthodontic correction. This requires supporting records from a physician or speech therapist that predate the orthodontic request.
The Approval Process
Braces through Medicaid require prior authorization in every state. This means you can’t simply walk into an orthodontist’s office and start treatment. The typical process looks like this: your child’s dentist identifies an alignment problem during a routine exam and refers you to an orthodontist. The orthodontist evaluates your child, takes X-rays and impressions, and then submits a treatment plan along with clinical documentation to Medicaid for approval.
The state’s dental reviewers assess whether the case meets the medical necessity criteria. This review can take several weeks to a couple of months. If approved, treatment moves forward with Medicaid covering the cost. If denied, you typically have the right to appeal the decision.
One important detail to clarify with the orthodontist before treatment begins: what happens if your child loses Medicaid eligibility during the course of treatment. Braces typically require 18 to 24 months of active care, and a change in your family’s income, a move to another state, or your child aging out of coverage could interrupt things. Ask the orthodontist’s office upfront about their policy for patients who lose coverage mid-treatment, including whether you’d owe the remaining balance out of pocket.
What It Costs With Medicaid
For children under 18, Medicaid-covered orthodontic treatment should cost nothing or close to nothing. Federal rules prohibit cost-sharing for EPSDT services for this age group, with narrow exceptions for certain medically needy enrollment categories. States can choose to extend this no-cost protection up to age 21.
That said, Medicaid reimbursement rates for orthodontics are lower than what private-pay patients are charged, which is the main reason many orthodontists don’t accept Medicaid. The ones who do participate have agreed to those rates, so you should not be billed for the difference. If an orthodontist asks you to pay extra beyond what Medicaid covers, that’s a red flag, and you should contact your state Medicaid office.
If Medicaid Doesn’t Cover Your Situation
If your child doesn’t meet the medical necessity threshold, or if you’re an adult without coverage, a few alternatives can reduce the cost of braces significantly. Dental schools with orthodontic residency programs offer treatment at reduced fees, often 30 to 50 percent less than private practice. Community health centers with dental departments sometimes provide orthodontic services on a sliding fee scale based on income.
Nonprofit programs also exist specifically for families who can’t afford braces. Smiles Change Lives partners with over 800 orthodontists across the U.S. and Canada to provide braces to children from lower-income families at a fraction of the typical cost. Their program is worth looking into if your child needs braces but doesn’t qualify through Medicaid, or if you’re on a waiting list and looking for faster options. Many private orthodontists also offer interest-free monthly payment plans that can make treatment more manageable even without insurance.