Braces are now covered by Medicaid in Oregon. Read below to find out more about the OHP Benefit:
The Oregon Health Authority (OHA) has officially updated the information about Medicaid coverage of the new orthodontic benefit. You can see the new information here: https://www.oregon.gov/oha/HSD/OHP/Tools/Orthodontic-Coverage-Fact-Sheet.pdf Your dentist or orthodontist can't tell you right away during your first evaluation visit if you qualify for the Orthodontic Medicaid Benefit or not. They might however determine that cavities or poor oral hygiene prevents you from getting braces so they might try to help you get that under control first, and then re-evaluate. They will take measurements and/or get an impression of your teeth and send for approval to your Coordinated Care Organization (CCO), who makes the final decision.
If you are denied the benefit, you will receive an official denial letter and have the right to appeal. If you are denied and you do not receive the letter of denial, you can ask for a copy of the denial letter. Please contact your CCO to address directly with them.
The Oregon Health Plan/Medicaid Orthodontic benefit (braces) has been in effect since January 1, 2023, for OHP Members under 21 years old. You can see the benefit in the OHP Member handbook (page 21) by clicking HERE.
Please begin by contacting your primary care dentist to schedule a Medicaid orthodontic evaluation or reach out to your Dental Care Insurance:
Open Card: Call 800-562-4620 or contact A Smile for Kids at 541-280-9799
ODS Community Dental: Call 800-342-0526 or visit your primary care dentist
Advantage Dental: Call 866-268-9631 or visit your primary care dentist
Capitol Dental Care: Call 800-525-6800 or visit your primary care dentist
CareOregon Dental: Call 888-440-9912 or visit your primary care dentist
Willamette Dental Group: Call 855-433-6825 or visit your primary care dentist
Cascade Health Alliance: Call 888-989-7846 or visit your primary care dentist
Kaiser Permanente: Call 866-653-0338 or visit your primary care dentist
If you are 17 years or younger and have already completed an orthodontic evaluation with a dentist AND have received a Medicaid denial letter, we suggest you proceed with the ASK program intake form HERE. If you have not signed up for the Oregon Health Plan yet, click here to check your eligibility and how to sign up.