Does Medicaid Cover Braces? (2026)

Quick Answer: Children vs. Adults in 2026

It depends entirely on the patient's age. Children and young adults under 21 are covered in all 50 states through EPSDT, provided the treatment is medically necessary. Adults 21 and over depend on whether their state includes orthodontics in its optional adult dental benefit, and most do not cover cosmetic orthodontics. Families who earn too much for Medicaid may qualify for CHIP instead; see CHIP eligibility by state for income cutoffs.

How EPSDT Works for Children's Braces

EPSDT stands for Early and Periodic Screening, Diagnostic, and Treatment. Under federal law at 42 U.S.C. 1396d(r), every state Medicaid program must provide EPSDT services to all enrolled individuals under age 21. The mandate goes well beyond routine checkups: if a screening identifies that a child needs a specific treatment, the state must cover that treatment even if it is not listed in the state's standard adult Medicaid benefit package. Orthodontic treatment, including metal braces, clear aligners, and retainers, qualifies when a licensed dentist or orthodontist documents that it is medically necessary.

Under EPSDT, Medicaid pays the orthodontist directly. Families enrolled in Medicaid generally pay nothing out of pocket for covered orthodontic care. The treatment must be authorized by the state's Medicaid dental coordinator, and the orthodontist must be enrolled as a Medicaid provider. Not all orthodontists accept Medicaid, so the family may need to search for a participating provider through the state Medicaid member portal or by calling the member services number on the Medicaid card.

Adult Orthodontic Coverage: State by State

Adult orthodontic coverage under Medicaid is an optional benefit that states choose to include or exclude from their Medicaid state plans. The federal Medicaid statute does not require states to offer dental benefits to adults at all, though most states now provide at least emergency dental services. As of 2026, KFF data shows that fewer than 10 states cover any adult orthodontics under Medicaid, and almost all of those limit coverage to cases with documented medical necessity such as severe malocclusion (a measurable bite severity score), cleft palate sequelae, or jaw reconstruction following trauma or cancer surgery. For a full state-by-state breakdown of what adult dental services Medicaid covers, see our guide to dental coverage by state under Medicaid.

Medicaid expansion (which brought coverage to adults earning up to 138% of the federal poverty level, or $22,590 for an individual in 2026) expanded who qualifies for Medicaid but did not automatically expand dental benefits. A state that expanded Medicaid eligibility may still offer only emergency dental to its newly eligible adults. If you are an adult in a non-expansion state such as Texas, Florida, or Georgia, adult Medicaid dental coverage is even more limited: most non-expansion states restrict adult Medicaid dental to extractions and emergency pain relief only.

What Counts as Medically Necessary Orthodontics

Medicaid uses specific clinical criteria to determine when braces cross from cosmetic to medically necessary. State Medicaid dental programs typically rely on the Handicapping Labio-lingual Deviation (HLD) index or a similar severity score. An HLD score of 26 or above generally qualifies for medically necessary orthodontic treatment under most state Medicaid plans. Conditions that commonly meet the medical necessity threshold include: severe Class II or Class III skeletal malocclusion where teeth cannot function properly; congenital cleft palate or cleft lip requiring orthodontic preparation before and after surgical repair; crossbites or openbites that cause documented speech or chewing impairment; and orthodontic treatment necessary to position the jaw for orthognathic (jaw) surgery.

Cosmetic concerns alone (spacing, crowding that does not impair function, minor misalignment) do not meet medical necessity standards under Medicaid. The documentation process typically requires a written referral from the child's primary care dentist, a treatment plan from a Medicaid-enrolled orthodontist, photographs and X-rays showing the condition, and a completed state Medicaid prior authorization form. Denials are common when documentation is incomplete, so working with an orthodontist who has experience with Medicaid authorization requests is important.

How to Get Braces Covered Through Medicaid

Accessing Medicaid orthodontic coverage follows a predictable sequence. First, the child must be enrolled in Medicaid and income-eligible. Medicaid has no annual enrollment window: families can apply year-round at Medicaid.gov or their state Medicaid portal. If the child's family income falls above the Medicaid threshold, CHIP eligibility by state covers children at higher income levels and also includes orthodontic benefits in most states. For household income guidelines, our Medicaid income limits resource shows the 2026 federal poverty level thresholds by household size.

• Step 1: Confirm Medicaid enrollment. Call the member services number on the Medicaid card or visit your state Medicaid member portal to verify active coverage and dental benefits.
• Step 2: Get a dental referral. Visit a Medicaid-enrolled dentist for a comprehensive oral exam. Ask the dentist to document any orthodontic concerns and refer you to an orthodontist who accepts Medicaid.
• Step 3: Orthodontic evaluation. The Medicaid-enrolled orthodontist takes X-rays, photographs, and dental impressions, then completes a prior authorization request to the state Medicaid dental coordinator. The HLD score or equivalent severity index is typically submitted with this request.
• Step 4: Prior authorization. The state Medicaid dental program reviews the documentation and either approves or denies coverage. Approval times vary from 2 to 6 weeks. If denied, you have the right to appeal through the state fair hearing process.
• Step 5: Treatment. Once approved, braces placement begins. Medicaid pays the orthodontist directly for covered treatment. Periodic check appointments are also covered as part of the authorized treatment plan.

Alternatives When Medicaid Does Not Cover Braces

Adults who do not qualify for Medicaid orthodontic coverage have several alternatives worth considering. CHIP covers children who earn too much for Medicaid in most states, and CHIP dental benchmarks align with commercial insurance standards that typically include orthodontic benefits with orthodontic waiting periods. Families below 400% of the federal poverty level ($90,880 for a family of 4 in 2026) may qualify for ACA marketplace coverage with orthodontic add-on riders. Community health centers (Federally Qualified Health Centers, or FQHCs) offer sliding-scale dental services and can often facilitate orthodontic referrals. University dental schools provide orthodontic treatment at 50 to 70% below private practice rates. The National Foundation of Dentistry for the Handicapped (Dental Lifeline Network) provides free comprehensive dental care including orthodontic evaluation to adults with disabilities who cannot afford private dental care.

For adults who are dual-eligible (both Medicare and Medicaid), note that Original Medicare does not cover dental services including orthodontics. Some Medicare Advantage plans add supplemental dental benefits; if a Medicaid-covered adult also has Medicare Advantage, check whether the MA plan's supplemental dental benefit covers orthodontic services. Medicaid's cost-sharing assistance remains available for other covered services regardless.

Does Medicaid cover braces for my child?

Yes. Medicaid covers braces for children under 21 in all 50 states through the EPSDT benefit, which requires medically necessary orthodontic care at no cost to the family. The child must be enrolled in Medicaid and the orthodontist must document that treatment is medically necessary using a severity index such as the HLD score. Cosmetic straightening alone does not qualify.

Does Medicaid cover braces for adults?

Rarely. Adult orthodontic coverage is an optional Medicaid benefit and most states exclude it or restrict it to documented medical necessity cases such as severe malocclusion, cleft palate, or jaw surgery. Fewer than 10 states cover any adult orthodontics under Medicaid as of 2026. Check with your state Medicaid dental program directly to find out your state's policy.

What is EPSDT and how does it apply to braces?

EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) is the federal Medicaid benefit for people under 21. Under federal law, every state must provide any medically necessary treatment identified through an EPSDT screening, including orthodontic treatment. If a dentist determines a child needs braces for medical reasons, Medicaid must cover it even if the state's standard adult dental plan would not.

What score do I need for Medicaid to approve braces?

Most states use the Handicapping Labio-lingual Deviation (HLD) index. A score of 26 or above typically meets the medical necessity threshold in states that use this tool. Some states use different scoring systems. The orthodontist you see will complete the scoring as part of the prior authorization paperwork and submit it to the state Medicaid dental coordinator.

Does CHIP cover braces?

Yes, in most states. CHIP (Children's Health Insurance Program) covers children in families who earn too much for Medicaid but still have limited income. CHIP dental plans are benchmarked to commercial insurance standards, and orthodontic benefits are included in most states' CHIP plans when medically necessary. Check CHIP eligibility in your state if your child doesn't qualify for Medicaid.

How do I find an orthodontist who accepts Medicaid?

Use your state Medicaid member portal's provider directory and filter for orthodontists. You can also call the member services number on the Medicaid card and ask for a list of participating orthodontists. Not all orthodontists accept Medicaid, so it may take a few calls. Federally Qualified Health Centers (FQHCs) often have dental departments that can provide referrals to Medicaid-enrolled orthodontists.

What happens if Medicaid denies coverage for braces?

You have the right to appeal. The denial notice must come in writing and explain the specific medical necessity reason for the denial. You can request an internal appeal with the Medicaid managed care plan and, if that fails, a state fair hearing through the state Medicaid agency. Denials often succeed on appeal when the orthodontist provides additional clinical documentation. The appeal window is typically 30 to 90 days from the denial date.

Are braces covered if I have both Medicare and Medicaid?

Original Medicare does not cover dental care including braces, so Medicare provides no orthodontic benefit regardless of age. If you are dual-eligible and under 21, Medicaid's EPSDT requirement still applies and Medicaid covers medically necessary orthodontics. If you are dual-eligible and 21 or older, only your state Medicaid plan's adult dental coverage applies, and most states do not cover adult orthodontics.