Medicaid Braces in Greeley CO (Health First Colorado)

We accept Health First Colorado (Colorado Medicaid) at our Greeley CO orthodontics clinic. If your child has a severe bite problem and meets the medical-necessity criteria, Medicaid may cover comprehensive orthodontic treatment. Coverage decisions are made by Health First Colorado after prior authorization. (HCPF, DentaQuest)

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Who Qualifies for Medicaid Braces in Greeley CO?

• Age: Benefits apply to children and teens through age 20 (must be age 20 or younger at the time of authorization). (DentaQuest)
• Medical necessity: Medicaid covers orthodontics only for severe, handicapping malocclusion (not for cosmetic reasons). A standardized Orthodontic Criteria Index is used during review. (DentaQuest)
• Cost to members: For covered children’s dental services, there are no additional costs to members; providers that accept Medicaid must treat Medicaid’s payment as payment in full (no balance billing). (HCPF)
• Adults: Medicaid orthodontic coverage for adults is extremely limited and generally restricted to specific, severe conditions with additional medical approval. (Colorado Secretary of State)

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What Medicaid Typically Covers for Orthodontics

Health First Colorado reimburses orthodontics as a comprehensive “case” (global) benefit for approved members. That case generally includes the records, appliance/banding, periodic visits (adjustments), and debond; initial retainers are typically included, while lost/broken retainer replacements or repairs may be billed separately. (Exact billing follows state fee schedules and guidelines.) (Colorado Dental Association, DentaQuest)

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Our 3-Step Medicaid Braces Process

1) Records & Exam (Visit 1)
We take photos, X-rays/CBCT as needed, and measurements. If Medicaid coverage looks feasible, we proceed with prior authorization paperwork.

2) We Submit to Medicaid (Prior Authorization)
We complete the Orthodontic Criteria Index form, attach required images/X-rays, and submit to Health First Colorado’s dental plan (DentaQuest) for review. (DentaQuest)

3) Decision (Usually ~2 Weeks)
Most decisions arrive in about 2 weeks (timing can vary). If approved, treatment can begin with no out-of-pocket cost for covered services, as long as Medicaid eligibility is maintained throughout treatment. (HCPF)

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Keep Your Coverage Active During Treatment

Coverage continues only while Medicaid eligibility is active. If eligibility lapses, Medicaid payments pause until eligibility is reinstated (which may delay treatment). Please keep your case worker info up to date and respond promptly to renewal notices. (This is standard for EPSDT-age dental benefits.) (Colorado Community Health Alliance)

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What We Submit (Typical Checklist)

• Diagnostic photos (intraoral/extraoral) and panoramic/ceph X-rays
• Study models or digital scans
• Index scoring sheet & narrative of medical necessity (per the Colorado Orthodontic Criteria Index) (DentaQuest)

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Frequently Asked Questions

Is every child approved?
No. Approval requires meeting medical-necessity criteria for severe malocclusion; cosmetic crowding/spacing alone usually isn’t covered. (DentaQuest)

What if my child turns 21 during treatment?
Approval must occur at age 20 or younger. Case-rate policies and continuing coverage after aging-out follow state rules; we’ll guide you based on your approval. (DentaQuest)

Are there co-pays?
For covered children’s dental services, no additional costs to members. Providers that accept Medicaid must accept Medicaid’s payment as payment in full for covered services. (HCPF)

What if retainers break or are lost?
Replacements/repairs are often covered under specific codes subject to rules/limits. We’ll verify benefits and obtain authorization as required. (DentaQuest)

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What to Bring to Your First Visit

• Medicaid ID (Health First Colorado card)
• Photo ID for parent/guardian
• Any prior dental/X-ray records (optional but helpful)

*Sourced from ChatGPT