DoesMedi-CalCoverBraces?OptionsinLongBeachandGardenGrove

Medi-Cal Dental covers braces for members under 21 when the case meets the state's medical necessity rules, which are scored on a form called the HLD Index. Bloom does not accept Medi-Cal, but if Medi-Cal turns down orthodontic treatment because a patient does not qualify on the HLD form, we can still treat them in our office with in-house payment plans.

This page explains how Medi-Cal decides on braces, what a denial means, and what your options are at Bloom in Long Beach and Garden Grove.

How Medi-Cal Decides on Braces

The California Department of Health Care Services (DHCS) runs Medi-Cal Dental's EPSDT benefit for full-scope members under age 21. For orthodontics, DHCS uses the Handicapping Labio-Lingual Deviation (HLD) Index Score Sheet:

Step	What DHCS describes
Who is eligible	Full-scope Medi-Cal members under age 21
How a case qualifies	A score of 26 points or more on the HLD Index, or one of six automatic qualifying conditions
How it is requested	The provider submits a Treatment Authorization Request (TAR) with the HLD score sheet and diagnostic casts
Cost to the member	EPSDT services are without cost for eligible members

DHCS also describes cases that score under 26 but may still be approved when other documentation shows medical necessity, such as a speech pathologist's finding that the bite is a main cause of a speech problem.

If Medi-Cal Denied Your Child's Braces

A denial based on the HLD score means Medi-Cal decided the bite does not meet its medical necessity rules. Your child can still have orthodontic treatment outside Medi-Cal. At Bloom:

1. We can still treat your child. Bloom does not accept Medi-Cal, and patients whose Medi-Cal orthodontic request was denied for not qualifying on the HLD form can be treated in our office.
2. In-house payment plans spread the cost. We offer low and no-interest monthly plans and go over the terms at your consultation.
3. The first visit is free. Your complimentary consultation with one of our board-certified orthodontists, Dr. Thao Nguyen Vu or Dr. Judy Nguyen, includes X-rays, records, and a treatment simulation. Children can see us without a dentist referral.

What Treatment Costs at Bloom

For families paying through a payment plan, Bloom's published fees are:

Treatment	Bloom fee range
Early (Phase 1) treatment	$2,500 to $3,500
Teen orthodontics	$3,500 to $5,500
Traditional metal braces	$3,500 to $5,500
Clear (ceramic) braces	$4,000 to $5,500

Your exact fee is set after the exam. See our teen braces cost and metal braces cost guides for what moves the fee.

Other Help for Families

The American Association of Orthodontists lists Gifted Smiles, Smiles Change Lives, and Smile for a Lifetime as programs that provide orthodontic treatment to children under 18 at low or no cost. HSA and FSA funds can also be used, since IRS Publication 502 lists braces among the dental expenses that count as medical care.

Frequently Asked Questions

Does Bloom accept Medi-Cal?

No. Bloom does not accept Medi-Cal. If Medi-Cal denies orthodontic treatment because a patient does not qualify on the HLD form, we can still treat them in our office with in-house payment plans.

Does Medi-Cal cover braces?

For full-scope members under 21, Medi-Cal Dental covers braces that meet its medical necessity rules: a score of 26 or more on the HLD Index, or one of six automatic qualifying conditions.

Does Medi-Cal cover braces for adults?

The orthodontic rules DHCS describes for the EPSDT benefit apply to members under 21.

What is the HLD Index?

It is the Handicapping Labio-Lingual Deviation Index Score Sheet, the form DHCS uses to score how severe a bite problem is when deciding whether braces are medically necessary.

What can I do if my child was denied?

Book a free consultation at Bloom. We can treat patients who were denied for not qualifying on the HLD form, and we offer in-house payment plans.

Sources

• California Department of Health Care Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services
• American Association of Orthodontists, How Much Do Braces Cost?
• Internal Revenue Service, Publication 502, Medical and Dental Expenses
• Bloom financing: Insurance and financing

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Was your child's Medi-Cal braces request denied? Book a free consultation at our Long Beach or Garden Grove office.