North Carolina Medicaid covers braces for children under the age of 21 who meet certain criteria. The child must have a medical condition that requires braces, such as a cleft lip or palate, or a severe overbite or underbite. Medicaid will also cover braces for children who have difficulty speaking or eating due to a dental condition. To qualify for Medicaid coverage, the child must be a resident of North Carolina and meet the income and asset limits.
Eligibility Requirements for Medicaid Coverage in North Carolina
To qualify for Medicaid coverage in North Carolina, individuals must meet certain eligibility requirements. These requirements include:
- Income: Individuals must have an income that falls below a certain threshold. The income limit varies depending on the size of the household.
- Age: Children under 19 years of age are eligible for Medicaid coverage, regardless of their income.
- Pregnancy: Pregnant women are eligible for Medicaid coverage, regardless of their income.
- Disability: Individuals with disabilities may be eligible for Medicaid coverage, regardless of their income.
- Citizenship: Individuals must be U.S. citizens or legal residents to be eligible for Medicaid coverage.
In addition to these general eligibility requirements, there are also specific eligibility requirements for certain groups of individuals. For example, children in foster care and individuals who are receiving Supplemental Security Income (SSI) are automatically eligible for Medicaid coverage.
Individuals who are interested in applying for Medicaid coverage can do so through the North Carolina Department of Health and Human Services (DHHS). DHHS has a number of resources available to help individuals apply for Medicaid coverage, including online applications and phone assistance.
| Eligibility Category | Income Limit |
|---|---|
| Children under 19 | 138% of the federal poverty level |
| Pregnant women | 138% of the federal poverty level |
| Individuals with disabilities | 138% of the federal poverty level |
| Adults without children | 138% of the federal poverty level |
| Families with children | 200% of the federal poverty level |
Covered Dental Procedures Under Medicaid in North Carolina
Medicaid is a government-sponsored health insurance program that provides coverage for low-income individuals and families. In North Carolina, Medicaid covers a wide range of dental procedures, including:
- Routine preventive care, such as cleanings, exams, and fluoride treatments
- Restorative care, such as fillings, crowns, and bridges
- Emergency dental care, such as pain relief and treatment of infections
- Orthodontic care, such as braces and retainers
- Oral surgery, such as tooth extractions and implants
The specific dental services that are covered under Medicaid in North Carolina vary depending on the individual’s age and needs. For example, children under the age of 21 are eligible for a wider range of services than adults. Additionally, some services may require prior authorization from the state Medicaid office.
To learn more about the dental services that are covered under Medicaid in North Carolina, you can contact your local Medicaid office or visit the North Carolina Department of Health and Human Services website.
| Procedure | Covered for Children Under 21 | Covered for Adults |
|---|---|---|
| Routine preventive care | Yes | Yes |
| Restorative care | Yes | Yes |
| Emergency dental care | Yes | Yes |
| Orthodontic care | Yes | No |
| Oral surgery | Yes | Yes |
Medicaid Coverage for Orthodontic Treatment
Medicaid, a government-sponsored health insurance program, generally does not cover orthodontic treatment, including braces, for children or adults. However, there are some exceptions to this rule. Orthodontic treatment may be covered if it is deemed medically necessary to correct a severe dental or facial deformity that is negatively impacting a person’s overall health or function.
Coverage Criteria
- The orthodontic treatment must be deemed medically necessary by a qualified dentist or orthodontist. This means that the treatment is necessary to correct a severe dental or facial deformity that is negatively impacting the person’s overall health or function, such as a cleft lip or palate, or a severe overbite or underbite.
- The treatment must be approved by the state Medicaid agency prior to services being rendered. This is to ensure the treatment is truly medically necessary and not purely cosmetic.
- The patient must meet all other Medicaid eligibility requirements, such as income and asset limits, citizenship status, and residency requirements.
Benefits Covered
- If orthodontic treatment is approved, Medicaid will typically cover the cost of the braces, as well as any necessary follow-up appointments and adjustments.
- Medicaid may also cover the cost of other orthodontic appliances, such as retainers, space maintainers, and palatal expanders if they are deemed medically necessary.
- The specific benefits covered by Medicaid for orthodontic treatment may vary from state to state.
Exclusions
- Medicaid will not cover purely cosmetic orthodontic treatment, such as treatment to improve the appearance of teeth that are otherwise healthy and functional.
- Medicaid will not cover treatment by private orthodontists unless the patient is enrolled in a managed care plan that includes orthodontic coverage.
Applying for Coverage
To apply for Medicaid coverage for orthodontic treatment, individuals should contact their local Medicaid office. They will need to provide documentation of the dental or facial deformity, as well as proof of income and assets. Medicaid offices may have different application processes, so it’s best to contact the office directly for more information.
State-by-State Medicaid Coverage for Orthodontic Treatment
| State | Coverage | Restrictions |
|---|---|---|
| Alabama | No coverage | – |
| Alaska | Coverage for children under 21 with severe dental or facial deformities | – |
| Arizona | No coverage | – |
| Arkansas | Coverage for children under 21 with severe dental or facial deformities | – |
| California | Coverage for children under 21 with severe dental or facial deformities | – |
Does Medicaid Cover Braces in North Carolina?
Medicaid, a federal-state health insurance program, provides coverage to low-income individuals and families. While basic dental services are typically covered by Medicaid, orthodontic treatment, including braces, is not a covered service in most states.
Alternative Options for Affordable Orthodontic Treatment in North Carolina
If you are a North Carolina Medicaid recipient and need braces, several affordable options are available.
- Sliding Scale Dental Clinics – Sliding scale dental clinics offer dental services on a sliding scale based on income. These clinics may charge a reduced fee for orthodontic treatment or offer payment plans.
- Orthodontic Schools – Orthodontic schools offer orthodontic treatment at a reduced cost to patients who serve as teaching cases. These schools are staffed by experienced orthodontists and students in training, ensuring high-quality care.
- Dental Savings Plans – Dental savings plans are discount dental plans that can help you save money on orthodontic treatment and other dental procedures. These plans typically require an annual membership fee, but they can provide significant savings over the cost of traditional dental care.
- CareCredit – CareCredit is a healthcare financing company that offers low-interest financing for dental and medical procedures. This can be a good option for those who need braces but cannot afford to pay for them all at once.
Alternatively, you might explore the possibility of applying for state-funded exceptional needs policies if your child has specific medical and dental requirements.
NC Medicaid Dental Coverage
Medicaid covers basic dental services, including checkups, cleanings, fillings, tooth removal, and root canals. If you are under 21 and enrolled in Medicaid, you can receive orthodontic treatment through the state’s Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. EPSDT covers medically necessary treatment, which may include braces in some cases.
| Service | Covered |
|---|---|
| Checkups and cleanings | Yes |
| Fillings | Yes |
| Tooth removal | Yes |
| Root canals | Yes |
| Braces | Covered for children under 21 in some cases |
Hey folks! Thanks for sticking with me to the end of this deep dive into the world of braces and Medicaid coverage in North Carolina. I know it can be tough to navigate the ins and outs of healthcare, but I hope this article has shed some light on the subject. If you’re still feeling a bit lost, don’t hesitate to reach out to your Medicaid provider or a healthcare professional. They’re there to help you understand your coverage and make sure you’re getting the care you need. Keep an eye out for my future articles, where I’ll be tackling more healthcare topics in a fun and informative way. Until next time, stay healthy and keep smiling!