How do I know if my child's treatment is covered by Medi-Cal?

The Medi-Cal Dental program’s benefits include orthodontic care for medically necessary conditions. Orthodontic benefits are from age 13 to 21, with no extended services allowed. Patients must maintain eligibility throughout the entire treatment. At your child’s initial consultation we will complete a score sheet provided by Denti-cal.

If your child scores below 26 points on the Score Sheet or does not have one of the six automatic qualifying conditions, he/she will not be considered for treatment, and you will have the option of paying for any recommended treatment in full.

If your child scores 26 points or above on the Score Sheet or has one of the six automatic qualifying conditions, we will schedule an hour appointment to take the necessary records to submit to Denti-Cal. Such records may include 1 or more x-rays, molds of the top and bottom teeth, and photographs. The cost for records is $200.

After the records have been submitted to Denti-Cal it takes approximately 1 month to receive an authorization or denial of treatment. If the treatment is denied, you will receive a notice in the mail.

Once your child’s case has been reviewed by Denti-Cal and approved, we will call you to schedule him/her for placement of the braces (or other appliances). At that time we will refund the cost for records. Medi-Cal will only cover the records if your child’s case is approved. If you choose to proceed with the recommended treatment after receiving a denial, the $200 will be applied to your balance. You will not be reimbursed if your child’s case is denied by Medi-Cal AND you choose not to proceed with the recommended treatment.

We will do our best to obtain the necessary approvals!