Finding an orthodontist who works with Medicaid or CHIP in the Dallas area — and getting a straight answer about what’s actually covered — is harder than it should be. This guide gives you the honest picture: how Texas Medicaid and CHIP orthodontic coverage works, what “medically necessary” really means, what to expect from the approval process, and what options are available if coverage doesn’t apply.
We accept TMHP and MCNA at participating Thrive locations. Call your nearest office with your plan information and we’ll confirm coverage and availability before you schedule anything.
Find your nearest location — Allen, Frisco, Sachse, Richardson, North Dallas, or Dallas.
The short answer is: sometimes, for children, when treatment is considered medically necessary.
Texas Medicaid dental coverage for children falls under EPSDT (Early and Periodic Screening, Diagnostic, and Treatment), which requires that medically necessary dental services be covered for eligible children under age 21. According to Medicaid.gov, states must provide dental services to children covered by Medicaid that include relief of pain, restoration of teeth, and maintenance of dental health.
Orthodontic treatment — including braces — can qualify under EPSDT when the condition meets medical necessity criteria. But braces are not covered simply because teeth are crooked or for cosmetic improvement alone. The orthodontic issue must affect function, health, or development in a meaningful way.
For adults, Texas Medicaid dental coverage is significantly more limited. Adult dental benefits are determined at the state level, and orthodontic treatment for adults through Medicaid is rarely covered outside of cases involving injury, surgical rehabilitation, or severe medical necessity.
This is the question that determines whether Medicaid will approve braces for your child. Medical necessity for orthodontic treatment generally means the condition creates a functional or health-related problem — not just an aesthetic one.
The patient must have multiple of the conditions mentioned below:
Mildly crowded or slightly crooked teeth that are otherwise functional typically do not meet medical necessity criteria. The bar is a meaningful functional impairment, not a cosmetic concern.
The determination is made by the Medicaid or CHIP dental plan after reviewing submitted records — not by the patient or the dental office alone.
In Texas, Medicaid dental benefits for children are managed through contracted dental plans rather than directly through the state. The two primary plans are:
MCNA Dental — one of the largest Medicaid dental plans in Texas, covering millions of children enrolled in Texas Medicaid and CHIP. MCNA manages prior authorization for orthodontic treatment and determines medical necessity based on submitted documentation.
DentaQuest — another major Texas Medicaid dental plan administrator, providing similar services for eligible children in different plan assignments.
Your child’s specific plan depends on which managed care organization administers their Medicaid benefits and which dental plan is associated with it. Check your child’s Medicaid card or call 211 (Texas Health and Human Services) to confirm which dental plan manages their benefits.
We accept both MCNA and TMHP at participating Thrive locations. Call ahead to confirm orthodontic participation at the specific location nearest you.
If your child has at least 4 of the criteria mentioned above, here’s what the process typically looks like to get braces:
Before scheduling an orthodontic evaluation, confirm that your child’s Medicaid coverage is currently active and identify which dental plan manages their benefits. This avoids scheduling delays and eligibility surprises.
An orthodontic evaluation at a participating provider lets our team assess your child’s teeth, bite, and jaw development. We document clinical findings and determine whether the case may meet medical necessity criteria.
If the case appears to qualify, we take comprehensive diagnostic records — X-rays, photographs, digital scans, and bite measurements. These records form the basis of the prior authorization submission.
The dental office submits a prior authorization request to your child’s Medicaid dental plan. This includes the diagnosis, clinical documentation, records, and proposed treatment plan. The plan reviews the submission against their medical necessity criteria.
The plan issues a written decision — approval, denial, or a request for additional documentation. Approval authorizes treatment to begin. Denials can often be appealed if additional clinical documentation supports the case.
If approved, braces are placed and treatment proceeds with covered adjustment visits throughout the treatment period. Retainers at the end of treatment may also be covered depending on the plan.
The timeline from evaluation to treatment start varies — plan on several weeks for the prior authorization process. Starting early is important if your child is approaching age 21, since Medicaid pediatric dental benefits end at that point.
Even if your child doesn’t qualify for orthodontic coverage, Texas Medicaid and CHIP cover a comprehensive range of children’s dental services including:
These services are available at participating Thrive locations for children enrolled in Texas Medicaid and CHIP. Regular preventive care is fully covered and the most important benefit to use consistently — catching decay early under Medicaid is always better than treating a larger problem later.
According to Medicaid.gov, dental services for children under Medicaid must support maintaining dental health and treating conditions identified during screenings. Use those benefits every year.
Rarely. Invisalign and clear aligner therapy are generally not covered by Texas Medicaid or CHIP because they are more commonly associated with cosmetic treatment and because most Medicaid orthodontic approvals specify traditional fixed appliances (braces).
In exceptional cases involving specific medical documentation and plan approval, clear aligners may be authorized — but this is uncommon. For most Medicaid patients pursuing orthodontic treatment, metal braces are the covered treatment option.
If your child qualifies for Medicaid orthodontic coverage, braces are almost always the path. If you’re interested in Invisalign regardless of Medicaid status, our team can walk you through self-pay and financing options at your consultation.
If prior authorization is denied, or if your child’s case doesn’t meet medical necessity criteria, orthodontic treatment is still reachable through other options at Thrive.
In-house payment plans for orthodontic treatment spread the cost into monthly installments over the treatment period — no large upfront payment required. Many families find this makes braces or Invisalign genuinely manageable without Medicaid.
Healthy Smiles Discount Plan — our annual membership program provides a 20% discount on all Thrive services including orthodontic treatment for $89/year per adult. Ask about family member pricing.
Phased treatment — for cases involving mild to moderate concerns, limited orthodontic treatment addressing specific issues costs meaningfully less than comprehensive treatment. Your orthodontic team will discuss whether a limited treatment approach is appropriate for your child’s situation.
Appeal the denial — if prior authorization is denied and you believe the clinical documentation supports the case, a formal appeal is worth pursuing. Our team can help provide additional documentation to support the appeal.
CHIP (Children’s Health Insurance Program) provides health and dental coverage for children in families whose income is above Medicaid eligibility thresholds but who still need affordable coverage. In Texas, CHIP dental benefits are similar in structure to Medicaid children’s dental benefits — including potential orthodontic coverage when treatment is medically necessary.
The same prior authorization process applies. The specific CHIP dental plan managing your child’s benefits — MCNA or DentaQuest — determines coverage and authorization requirements.
If your child is on CHIP, the process for pursuing orthodontic coverage is essentially the same as for Medicaid. Call us with your child’s plan information and we’ll confirm participation and walk you through next steps.
To make the most of your child’s first orthodontic visit at Thrive:
The more specific the functional concerns you can describe, the stronger the documentation for a prior authorization submission.
Yes, but it’s extremely rare — for children under 21 when orthodontic treatment is determined to be medically necessary. Coverage is not automatic and requires prior authorization from the Medicaid dental plan. Cases that affect function, health, or development are most likely to qualify. Cosmetic improvement alone does not meet medical necessity criteria.
Texas Medicaid pediatric dental benefits, including potential orthodontic coverage, end when a child turns 21. Treatment that begins before age 21 while coverage is active may continue to be covered through completion depending on the plan terms.
Timelines vary by plan, but generally expect 2–4 weeks from submission to decision. More complex cases or those requiring additional documentation may take longer. Starting the process early is important — don’t wait until your child is close to the age 21 cutoff
This is one of the most important things to address before starting treatment. If your child loses Medicaid or CHIP eligibility during orthodontic treatment, payment responsibility for remaining treatment shifts to you. We discuss this with families before treatment begins and can structure a plan for the possibility of coverage changes. In-house payment plan options are available in this scenario.
Yes. Medicaid dental plan denials can be appealed. If your child’s prior authorization is denied, ask the plan for the specific reason and their appeal process. Additional clinical documentation — more detailed records, letters from other treating providers, or supplemental photos — can sometimes support a successful appeal. Our team can help provide documentation for appeals.
We accept TMHP and MCNA at participating locations. Call your nearest Thrive office to confirm current participation for orthodontic services specifically — general dental and orthodontic Medicaid participation can differ by location.
Thrive offers in-house payment plans for braces and Invisalign that spread costs into manageable monthly installments, a 20% orthodontic discount through our Healthy Smiles Discount Plan, and free consultations so you can understand your options before committing to anything.
Navigating Medicaid orthodontic coverage takes patience — but you don’t have to figure it out alone. Our team helps families understand their benefits, prepares thorough documentation for prior authorization, and presents every available option when coverage falls short.
Call your nearest Thrive location with your child’s Medicaid or CHIP plan information and we’ll take it from there.
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