Short answer: Florida Medicaid covers braces for children and teens under 21 when the treatment is medically necessary. It does not cover braces for straighter-looking teeth alone, and it does not cover braces for adults. Below is how “medically necessary” is decided, what the process looks like, and what your options are if Medicaid says no.
Who qualifies for braces through Florida Medicaid?
Florida Medicaid dental benefits are provided through three dental plans: DentaQuest, Liberty Dental and MCNA Dental. Orthodontic treatment (braces) is covered for members under 21 when an orthodontist documents a handicapping malocclusion — a bite problem that affects how the mouth works, not just how the teeth look.
Examples of problems that can qualify:
- A very deep overbite where the lower teeth bite into the roof of the mouth
- A severe overjet (upper teeth far in front of the lower teeth) or underbite
- A crossbite that is damaging the gums or bone
- Cleft palate and other craniofacial conditions
- Teeth that are badly displaced after an injury
Crooked or crowded teeth that don’t cause a functional problem usually do not qualify.
How the HLD score works
Florida uses an assessment based on the HLD Index (Handicapping Labio-Lingual Deviation). The orthodontist measures things like overjet, overbite, crowding and open bite and adds them into a score. A score of 26 or higher generally meets the threshold, and some severe conditions (such as cleft palate) qualify automatically when they are documented. The dental plan then reviews the records and approves or denies the request (this is called prior authorization).
Does Medicaid cover braces for adults in Florida?
No. For adults 21 and older, Florida Medicaid focuses on exams, cleanings, X-rays, fillings, extractions, deep cleanings and dentures. Orthodontics is not part of adult coverage. Adults who want braces usually pay through a payment plan or financing such as CareCredit.
What to do if your child’s braces are denied
- Ask for the denial in writing and the reason (for example, the score was below 26).
- Ask about an appeal. Your dental plan must explain how to appeal a decision.
- Re-evaluate later. Bites change as children grow; a new assessment in 6–12 months can score differently.
- Look at private-pay options. Payment plans and specials can make braces affordable even without Medicaid.
How much do braces cost if Medicaid doesn’t pay?
Nationally, metal braces average around $5,000–$5,500, with a wide range depending on the case. At Enjoy Dental we currently advertise a braces special of $250 per arch with a free orthodontic consultation and 50% off a maintenance cleaning. See our braces page or read how much braces cost in Florida.
Get your child checked in Hialeah
Enjoy Dental accepts Medicaid and most PPO plans. Dr. Nicte Boyle and Dr. Jheiny Garcia see children and adults, in English or Spanish. At the visit we can check the bite, explain whether it is likely to qualify, and tell you the next step.
Call (305) 871-9111 or book an appointment. Bring your child’s Medicaid card and the name of the dental plan.
This article is general information, not a guarantee of coverage. Your dental plan makes the final coverage decision.