Does Denti-Cal Cover Braces for Kids? What Parents Need to Know
- Contact Center
- Oct 6
- 5 min read
Updated: Oct 10
Introduction
For many California families, orthodontic care isn’t just about creating a beautiful smile—it’s about improving a child’s health, comfort, and confidence. Braces can correct serious bite problems, help with speech, prevent long-term dental complications, and improve self-esteem. But one big question remains for many parents:
Does Denti-Cal cover braces for kids?
The short answer: Yes, in certain cases.
Denti-Cal, which is the dental portion of California’s Medi-Cal program, does provide orthodontic coverage for children and teens. But braces are not covered for every child. Instead, treatment is only approved if it meets strict criteria for medical necessity.
This guide will walk you through everything parents need to know about Denti-Cal orthodontic coverage—including who qualifies, how the approval process works, what’s covered (and not covered), and what you can do to improve your child’s chances of getting approved.
What Is Denti-Cal?
Denti-Cal is the dental benefits program under Medi-Cal, California’s state health insurance for low-income individuals and families. It covers preventive, restorative, and specialty dental services. For orthodontics, coverage is limited to cases where braces are deemed medically necessary.
According to Rise Orthodontics, orthodontic coverage under Denti-Cal is:
Available only for children under age 21
Limited to severe bite problems or conditions affecting oral health
Granted only after prior authorization is approved
This means not every child who wants straighter teeth will qualify.
Why Braces Can Be Medically Necessary
Braces are often thought of as a cosmetic treatment, but orthodontics plays a major role in overall health. Some conditions that braces can correct include:
Difficulty chewing or biting – Misaligned teeth may prevent proper chewing.
Speech difficulties – Certain malocclusions affect how children pronounce sounds.
Oral health issues – Severe crowding increases cavity and gum disease risk.
Jaw problems – Malocclusion can lead to jaw strain, pain, or headaches.
Soft tissue damage – Certain bites cause teeth to cut into the gums or palate.
👉 Learn more in our blog: Why Orthodontics Is About More Than Just Straight Teeth.
Who Qualifies for Braces Under Denti-Cal?
Eligibility is based on strict guidelines outlined in California’s orthodontic Manual of Criteria.
1. Age Requirement
Children must be under 21 years old at the start of treatment. Once a patient turns 21, they are no longer eligible under Denti-Cal.
2. Medical Necessity
Braces must be needed to correct conditions that affect health or function—not for minor cosmetic adjustments.
3. HLD Index Score
The Handicapping Labio-Lingual Deviation (HLD) Index is used to measure severity. A score of 26 or higher is required to qualify (California Code of Regulations, Title 22).
Points are assigned for issues such as:
Overjet (horizontal protrusion of teeth)
Reverse overjet (underbite)
Open bite (teeth don’t meet when jaws close)
Crowding and spacing issues
Crossbites and overbites
4. Automatic Qualifying Conditions
Even if the HLD score is below 26, certain conditions qualify automatically:
Cleft palate deformity
Craniofacial anomalies
Severe traumatic deviations (such as jaw injury)
Deep overbite causing damage to the palate
Anterior crossbite damaging soft tissue
Overjet > 9 mm or reverse overjet > 3.5 mm with speech/chewing problems (Rise Orthodontics)
The Approval Process Step-by-Step
Getting braces through Denti-Cal isn’t instant. Parents should expect multiple steps:
Step 1: Orthodontic Evaluation
Your child’s orthodontist will conduct a full exam, including:
Dental X-rays
Photos
Impressions or 3D scans
Measurement of bite issues
👉 Learn more in our blog: What to Expect During Your Child’s First Orthodontic Visit.
Step 2: Treatment Authorization Request (TAR)
The orthodontist submits a TAR to Denti-Cal along with diagnostic records.
Step 3: Review and Scoring
If HLD Index ≥ 26 → case may be approved.
If under 26 but has automatic qualifying conditions → still approved.
If neither → case denied.
Unfortunately only about half of patients submitted to denti-cal are approved. And the approval process can take many months.
Step 4: Approval or Denial
Approved: Braces are covered, usually traditional metal braces.
Denied: Patients can proceed with treatment with a monthly payment plan
What Denti-Cal Covers
If approved, Denti-Cal usually covers:
Traditional braces (metal brackets and wires)
Orthodontic appliances needed for correction
Regular orthodontic adjustment visits
Retainers (basic, first set) after treatment
What Denti-Cal Does Not Cover
Braces for orthodontic treatment that do not fit Denti-cal’s strict criteria explained above
Orthodontic treatment for patients over 21
“Upgraded” options like ceramic braces or Invisalign
Replacement retainers or additional appliances not part of the treatment plan
Unfortunately, in many cases, patients have severe orthodontic needs that require treatment but are not covered by Denti-cal.
Why Early Orthodontic Screenings Matter
The American Association of Orthodontists (AAO) recommends that children have their first orthodontic check-up by age 7 (AAO – Child Orthodontics).
Even if braces aren’t needed yet, an early visit can:
Identify potential bite issues early
Track growth and jaw development
Allow for early intervention if necessary
Help families prepare for potential Denti-Cal approval later
👉 See our post: When Should My Child Get Braces?.
Practical Tips for Parents
Don’t wait – Schedule orthodontic screenings early.
Choose the right provider – Not all orthodontists accept Denti-Cal. Ask first.
Keep dental care up-to-date – Cavities and gum issues must be treated before orthodontics can start.
FAQs
Q: What is the HLD Index and why does it matter?
A: The Handicapping Labio-Lingual Deviation Index is a scoring system used to measure the severity of bite issues. A score
of 26 or higher is required for most approvals.
Q: What if my child doesn’t score 26?
A: They may still qualify if they have an automatic qualifying condition like cleft palate or severe overjet.
Q: How long does approval take?
A: It usually takes several months and in some cases as many as six.
Q: Does Denti-Cal cover Invisalign?
A: No, only braces.
Q: Can my teenager qualify?
A: Yes, however their coverage will end if they lose Medi-Cal coverage or turn 21.
Q: Are retainers covered?
A: The first set is usually included, but replacements are not.
Q: What if my child is denied coverage?
A: Patients can move forward with monthly payment plans in the office.
Internal Resources You Should Read
External Helpful Resources
Conclusion
So, does Denti-Cal cover braces for kids?
Yes—but only if your child meets strict medical necessity criteria. That means being under 21, scoring 26+ on the HLD Index, or having an automatic qualifying condition.
If you are interested in braces for yourself or your child the best next step is to schedule an orthodontic evaluation. At Sola Kids Dental & Orthodontics, we help families navigate the Denti-Cal approval process, submit authorizations, and provide high quality and affordable orthodontic care for kids and teens.
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