subject: Potential Changes In Medicaid Coverage For Orthodontists And Braces [print this page] In 2011 a small television station in a metropolitan area of Texas uncovered some seriously alarming numbers. The documents in question were obtained during an investigation into braces and Medicaid use in the state. They show that the state of Texas spent $184 million on orthodontic care under Medicaid in the year 2010.
This number was more than the rest of the forty-nine states in the Union spent on the same matter put together. It was nine times what the state of California spent in the same time. Under the Medicaid procedures, no braces are covered under the medical coverage program unless they are medically necessary. This means that no cosmetic Medicaid braces are to be covered. However, many dentists and orthodontists say that this happens more and more often. A national board has been convened in Washington, DC to look into this matter.
Another alarming number that came out of these documents is that over 24 percent of the people who got braces under Medicaid were under the age of twelve. Stephanie Goodman, a Texas Health and Human Services spokeswoman, said kids younger than 12 can get braces that are paid for by Medicaid only in severe cases, or when they've lost all their baby teeth. However, that didn't stop 18,898 kids under twelve from getting braces in 2010.
So how is this going to affect Medicaid braces coverage in the rest of the United States? It's a distinct possibility that many other states that have a "no cosmetic clause" in their Medicaid policies are also allowing several kids to slip through the cracks and prescribing them braces that are covered by the low income provider. With the scrutiny focused on this area of the program it is likely that there will be a severe crackdown on orthodontists across the country. Obviously this will start in Texas where there seems to have been an intense abuse of the program but a serious concentrated effort may now focus on programs across the country. Policies will no doubt be more heavily enforced when it comes to Medicaid braces.
If you, your child, or someone in your family who is covered by Medicaid and needs braces, read over your particular policy and pay close attention to the section about orthodontics and Medicaid. It could save you a lot of headaches and a lot of questions at your dentist's office. It can also save you the expense of getting the braces and then finding out that you aren't actually covered by your insurance policy.
by: Mark Etinger
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