Are Braces Covered by Denti-Cal? A Complete Guide for Parents

If your child needs braces and your family has Denti-Cal (also called Medi-Cal dental coverage), you’re probably wondering: are braces covered by Denti-Cal? The short answer is yes—but only when they’re deemed medically necessary by Denti-Cal.

At Marshall Orthodontics in La Mesa, Dr. Marshall accepts Denti-Cal and helps families understand the approval process. This guide explains everything you need to know about getting braces through Denti-Cal, who qualifies, and how to get started.

What Is Denti-Cal Orthodontic Coverage?

Denti-Cal is the dental benefits program that comes with Medi-Cal, California’s health coverage for low-income families. If your child has Medi-Cal, they automatically have dental benefits—you don’t need to apply separately.

While Denti-Cal covers regular dental care like cleanings and fillings, braces work differently. Coverage for braces is only available when the treatment is medically necessary, not for cosmetic reasons.

Who Qualifies for Denti-Cal Braces?

Not every child with crooked teeth will qualify for coverage. Denti-Cal uses strict rules to decide who gets approved.

Age Requirements

Your child must be:

Under 21 years old
At least 13 years old OR have lost all their baby teeth

The Point System

Denti-Cal uses something called the HLD Index (Handicapping Labio-Lingual Deviation Index) to score how serious your child’s dental problems are. Think of it like a report card for teeth alignment.

The orthodontist measures things like:

How crowded the teeth are
How much the top teeth stick out (overjet)
How the top and bottom teeth meet when biting
Gaps between teeth
Crossbites or open bites

Your child needs 26 points or higher to qualify. Only about half of the cases submitted get approved, so the problems need to be significant.

Automatic Qualifications

Some conditions automatically qualify without needing to reach 26 points. A few examples are:

Severe overjet where the top teeth stick out a lot
Severe overbite where bottom teeth hurt the roof of the mouth
Certain types of crossbite damaging the gums or inside of the mouth

Why Denti-Cal Coverage Matters for Your Family

Braces can cost thousands of dollars without insurance. For many families, that’s just not possible. Denti-Cal removes that financial barrier when your child truly needs treatment.

Health Benefits Beyond a Straight Smile

Often, when kids qualify for Denti-Cal braces, it’s because their bite problems affect more than just appearance:

Better eating: Severe bite issues make it hard to chew food properly, which can affect nutrition and digestion.

Clearer speech: Some dental problems cause speech difficulties that impact how your child communicates and feels in social situations.

Easier cleaning: Crowded or overlapping teeth are harder to brush and floss, leading to more cavities and gum disease.

Less pain: Bite problems can cause jaw pain, headaches, and uneven wear on teeth that gets worse over time.

Financial Relief

If your child gets approved, Denti-Cal covers:

Metal braces
Regular adjustment appointments
The first set of retainers after treatment

You won’t pay anything out of pocket for covered services.

How to Get Braces Through Denti-Cal

The process takes time and patience, but understanding the steps helps you know what to expect.

Step 1: Schedule an Orthodontic Evaluation

Find an orthodontist who accepts Denti-Cal—not all practices do. At Marshall Orthodontics, Dr. Marshall welcomes Denti-Cal patients and families.

Important timing note: Dr. Marshall strongly recommends bringing your child in for an orthodontic evaluation by age 12 at the latest. (It’s best to bring your child in at age 7, however.) Some orthodontic treatments work best during specific growth stages. If you wait too long, certain options may no longer be available. Getting evaluated early ensures you don’t miss the ideal treatment window.

You don’t need a referral to schedule this appointment. Just call.

Step 2: The Examination

During your visit, Dr. Marshall will do a screening exam and evaluate whether your child might qualify. Dr. Marshall and her team will also usually take x-rays as well.

If treatment is recommended and she thinks your child may qualify, we will schedule you for an orthodontic records appointment.
If treatment is recommended but your child will not qualify, we will offer financial options to pay out-of-pocket.

Step 3: Orthodontic Records

During this visit, Dr. Marshall’s team will take orthodontic records, which may include:

Take photos and x-rays of your child’s teeth
Make impressions (molds) of the teeth

Dr. Marshall will then review the orthodontic records and complete the HLD Index scoring to determine if your child meets Denti-Cal’s criteria.

Step 4: Submission to Denti-Cal

If it looks like your child qualifies, the orthodontist’s office sends all the documentation to Denti-Cal. This includes:

Photos
X-rays
Dental impressions
The completed HLD score sheet

The office handles this paperwork for you.

Step 5: Wait for Approval

This is often the hardest part. Denti-Cal reviews can take several months. They look at all the information and decide if the case meets their requirements.

About half of submitted cases get approved. If your child doesn’t qualify, Dr. Marshall can discuss affordable payment options so your child can still get the care they need.

Step 6: Start Treatment

Once approved, treatment can begin! Your child will come in for regular appointments (usually every 4-8 weeks) to get their braces adjusted. Treatment typically takes 24 months, though complex cases may take longer.

What Denti-Cal Covers (and What It Doesn’t)

What’s Included

Traditional metal braces
All adjustment appointments during treatment
The first set of retainers when braces come off
Emergency visits if something breaks

What’s Not Covered

Replacement retainers if your child loses them (some exceptions)
Clear aligners (like Invisalign)
Cosmetic orthodontic treatment
Treatment after your child turns 21
Treatment if you lose Medi-Cal coverage during braces

Take good care of retainers! Replacements come out of your pocket.

Common Questions Parents Ask

Q: My child has Medi-Cal. Is that the same as Denti-Cal?

Yes! Denti-Cal is just the name for the dental part of Medi-Cal. If your child has Medi-Cal, they automatically have Denti-Cal dental benefits.

Q: Can my child get clear aligners instead of metal braces?

Usually, Denti-Cal only covers traditional metal braces. Clear aligners aren’t typically an option through the program.

Q: What happens if we lose Medi-Cal coverage during treatment?

If your child loses coverage or turns 21 while wearing braces, Denti-Cal stops paying. You would need to work out a payment plan with the orthodontist to finish treatment.

Q: My child’s teeth aren’t that bad. Will they still qualify?

Probably not. Denti-Cal only covers cases where teeth or bite problems cause real functional issues. Mild crowding or slightly crooked teeth usually don’t meet the requirements.

Q: How long does the approval process take?

From the time the orthodontist submits the case, it can take anywhere from a few weeks to several months. Every case is different, and Denti-Cal processes a high volume of requests.

Q: What if Denti-Cal denies my child’s case?

If your child doesn’t get approved, you have options. Many orthodontists (including Marshall Orthodontics) offer affordable payment plans.

Q: Do all orthodontists accept Denti-Cal?

No. Most private orthodontic practices don’t participate in the Denti-Cal program. That’s why it’s important to find a provider like Marshall Orthodontics who accepts Denti-Cal patients.

Things You Should Know Before Applying

Keep Your Coverage Active

Your child needs to maintain Medi-Cal coverage throughout the entire treatment. Make sure to renew your coverage on time and report any changes in income or household size that could affect eligibility.

Take Care of Teeth First

Before braces can go on, your child needs to have healthy teeth and gums. That means:

All cavities filled
Gum disease treated
Regular cleanings up to date

Schedule these appointments with your child’s regular dentist before the orthodontic work begins.

Commitment Is Required

Braces require dedication. Your child will need to:

Brush and floss carefully every day
Avoid certain foods that can damage braces
Come to all adjustment appointments
Wear rubber bands or other appliances as directed
Wear retainers after braces come off

Missing appointments or not following instructions can delay treatment and affect results.

The Timeline Is Long

From first evaluation to removal of braces, the process often takes 2-3 years or more. The approval process alone can take months. Be patient and stay in touch with the orthodontist’s office about your case status.

Why Choose Marshall Orthodontics for Denti-Cal Braces

At Marshall Orthodontics in La Mesa, Dr. Marshall understands the challenges families face when seeking orthodontic care through Denti-Cal. Here’s what makes our practice different:

We accept Denti-Cal: Many orthodontists in the area don’t participate in the program. Dr. Marshall believes every child deserves access to quality orthodontic care, regardless of insurance type.

We handle the paperwork: Our experienced team knows exactly how to document and submit cases to give your child the best chance of approval.

We offer flexible options: If your child doesn’t qualify for Denti-Cal coverage, we have affordable payment plans to make treatment possible.

We care about timing: Dr. Marshall emphasizes the importance of early evaluation (by age 12) to make sure your child doesn’t miss the ideal treatment window for the best results.

We create a welcoming environment: We treat every patient with respect and dignity, making sure your family feels comfortable throughout the entire process.

Get Started Today

If you’re wondering whether your child qualifies for braces through Denti-Cal, the first step is scheduling an evaluation. Don’t wait—the earlier you get your child assessed, the better.

Dr. Marshall and her team at Marshall Orthodontics are here to help La Mesa families access the orthodontic care their children need. Whether your child qualifies for Denti-Cal or needs alternative payment options, we’ll work with you to find a solution.

Ready to learn more? Call Marshall Orthodontics at (619) 670-4018 or visit our Request an Appointment page to schedule your child’s evaluation. Dr. Marshall looks forward to helping your child achieve a healthy, beautiful smile.

Marshall Orthodontics proudly serves families in Spring Valley and surrounding communities. Dr. Marshall accepts Denti-Cal and offers braces and aligners for patients of all ages. For more information on whether braces are covered by Medi-Cal Dental (Denti-Cal), visit Medi-Cal’s website.