Medicaid and Orthodontics in Henrico, VA: What’s Typically Covered

Families searching “orthodontist medicaid” in Richmond, Henrico, or Midlothian often find coverage rules confusing. The good news: with the right guidance, you can navigate Virginia Medicaid orthodontic benefits confidently. At Horsey Orthodontics, our team helps families understand eligibility, documentation, and next steps, so you can focus on your child’s smile. Visit our location pages for convenient care in Richmond, Henrico, and Midlothian.

Quick answer: When does Medicaid cover orthodontics?

In Virginia, Medicaid may cover braces for children under 21 when treatment is medically necessary and approved through prior authorization. Dental benefits are administered by DentaQuest through Smiles For Children/Cardinal Care Smiles. Start with a free consultation to review eligibility and documentation.

Medicaid braces for kids and teens (under 21)

“Medically necessary” orthodontics means the bite problem affects health and function, not just appearance. Examples include severe crowding that impacts eruption, crossbites/underbites that impair chewing, speech issues related to jaw position, impacted teeth, and growth/development concerns.

During an evaluation, expect your orthodontist to gather:

• Photos, X‑rays, and impressions or digital scans
• A clinical exam and treatment notes explaining why care is needed
• A proposed plan (e.g., braces, duration, goals)

Every case requires prior authorization, and decisions are made case by case by DentaQuest reviewers. For children in foster care or under guardianship, bring any custody paperwork and your child’s Medicaid card so benefits can be coordinated correctly.

Orthodontist Medicaid and adults (21+)

For adults, Virginia Medicaid generally does not cover orthodontic treatment. While many adult dental services are available, orthodontics is typically excluded unless tied to rare, complex medical conditions. If you’re exploring options, we offer affordable alternatives and flexible financing.

• Explore discreet options like clear aligners
• Review costs with our payment calculator
• Get answers in our Orthodontic FAQs

Step-by-step: How to pursue Medicaid‑covered braces in Virginia

1. Schedule an evaluation
   Book a free consultation. Bring your child’s Medicaid card, any recent X‑rays, dentist notes, and your ID.
2. Benefit verification and documentation
   Our team confirms eligibility with DentaQuest and gathers all required photos, X‑rays, scans, and clinical notes. Learn more about our approach on Our Practice and meet the team on Meet Our Doctors.
3. Prior authorization submission
   We submit the request to DentaQuest with supporting documentation. Behind the scenes, case reviewers determine whether the condition meets medically necessary criteria.
4. Approval/denial timelines
   Most families hear back in about 2–4 weeks. If denied, we can discuss reconsideration or appeal pathways.
5. Starting treatment
   If approved, your child is scheduled for placement (braces or the least‑costly effective appliance) with regular check-ins to monitor progress.

Finding an orthodontist who handles Medicaid cases

Not every office accepts Medicaid; participation depends on network agreements and appointment availability. In Virginia, look for offices that work with DentaQuest for medically necessary orthodontics near Richmond, Henrico, and Midlothian.

Questions to ask when you call:

• Does the office see Medicaid patients under 21 for orthodontics?
• Do you handle prior authorizations for Virginia Medicaid/Cardinal Care Smiles?
• What documents should I bring to the consult, and how long are approvals taking?

What’s typically not covered (and common misconceptions)

• Cosmetic-only care without functional bite issues
• Premium brand requests (e.g., clear aligners) when braces are the least‑costly effective option
• Replacement retainers beyond the initial covered set, lost/broken appliance fees, and missed-appointment charges

Considering aligners? Review our guide on Invisalign treatment in Richmond, VA.

If you don’t qualify: Affordable options families choose

• In-house payment plans with low down payments
• Third‑party financing and the option to use HSA/FSA funds
• Limited-scope or early interceptive treatments to address the most urgent needs
• Local resources when available; see Patient Resources

FAQs about “orthodontist medicaid” in Virginia

• Does Medicaid cover Invisalign?
  Generally no. Virginia Medicaid covers the least‑costly effective treatment. Clear aligners are rarely approved unless they’re the only effective option.
• Do I need a referral to see an orthodontist?
  A referral isn’t typically required, but bringing your dentist’s notes and X‑rays can help. Check our Orthodontic FAQs.
• How long does approval take?
  Most decisions arrive in 2–4 weeks, though timelines can vary.
• Can I appeal a denial?
  Yes. We can request reconsideration or help you file an appeal with additional documentation.
• Is transportation help available?
  Virginia Medicaid offers non-emergency medical transportation. Call the number on your Medicaid card for scheduling guidance.

Why choose Horsey Orthodontics

• Board‑certified orthodontist with kid‑friendly and adult‑focused spaces
• Deep experience coordinating documentation for medically necessary orthodontics and explaining benefits in plain language
• Two convenient locations in Henrico and Midlothian with flexible scheduling
• Free consultation and benefits check schedule online or contact us

Ready to get started?

Schedule a free consult to review your case and benefits. Please bring your Medicaid card (and MCO card if you have one), plus any recent X‑rays or notes from your dentist. We’re here to help Richmond families make confident decisions about orthodontic care.