We Accept Medicaid for Orthodontic Treatment in San Antonio, Tx
Finding an orthodontist in San Antonio who accepts Medicaid and CHIP can feel overwhelming, but at Lucent Orthodontics and Dental Specialists, we make it simple. We proudly accept Texas Medicaid and CHIP for qualifying orthodontic treatment because we believe that the type of insurance your family carries should never determine whether your child has access to a healthy, confident smile.
If you have been searching for a “Medicaid orthodontist near me” or wondering whether your child’s Medicaid or CHIP plan covers braces, you are in the right place. This page will walk you through everything you need to know — from how Medicaid orthodontic coverage works in Texas, to the three dental plans that administer your child’s benefits, to the step-by-step process we follow to help your family get the care your child needs.
Dr. Shakourian and our team treat every Medicaid and CHIP patient with the same level of clinical excellence, personal attention, and genuine warmth that every patient at our practice receives. There is no difference in the quality of care — only a difference in how it is paid for. Your child deserves the best, and that is exactly what we deliver.
Let’s Make Your Smile Affordable
152 Fairmont Parkway, Pasadena, TX, 775041
☎ Call 210-361-2000
✉ lucent@satxdentalgroup.com
How Medicaid Orthodontic Coverage Works in Texas
In Texas, Medicaid may cover orthodontic treatment for children and young adults through age 20 under the Texas Health Steps (EPSDT) program when the case meets specific medical necessity criteria. This means the patient must have a severe handicapping malocclusion — a significant, measurable misalignment of the teeth or jaws that affects oral health or function — not just a cosmetic concern.
Effective October 1, 2024, Texas Medicaid updated its orthodontic benefit criteria to define three levels of orthodontic services, each requiring prior authorization and corresponding to different treatment complexities and durations. Our team stays current with all Medicaid policy changes to ensure your family receives every benefit available.
The process for determining Medicaid eligibility for orthodontic treatment involves the following steps:
Step 1. Initial Evaluation
Dr. Shakourian performs a comprehensive orthodontic evaluation, including an examination of the teeth, bite, and jaw alignment. She will take any necessary X-rays and records to fully assess the case and determine the severity of the malocclusion.
Step 2. Scoring and Documentation
If Dr. Shakourian determines that the case may qualify for Medicaid coverage, she will document the severity of the malocclusion using the criteria required by the state of Texas. Texas Medicaid recognizes three levels of orthodontic services for severe handicapping malocclusion, each requiring different amounts of treatment time.
Step 3. Prior Authorization Submission
Our team submits a prior authorization request to your Medicaid managed care dental plan along with the necessary records and documentation. This request asks the plan to approve coverage for the appropriate level of orthodontic treatment. Prior authorization is required for all levels of orthodontic services in Texas.
Step 4. Approval and Treatment
Once prior authorization is received, treatment can begin. Our team manages the entire authorization and claims process, keeping you informed at every step so there are no surprises.
It is important to understand that not every orthodontic case will qualify for Medicaid coverage, as the state requires that the condition meets a specific severity threshold for medical necessity. Cosmetic-only cases are not covered. However, even if Medicaid does not cover your child’s treatment, our flexible payment plans can make braces affordable for your family. Dr. Shakourian will be completely transparent about eligibility during your free consultation.
Texas Medicaid and CHIP Dental Plans
In Texas, children’s dental benefits under Medicaid and CHIP are administered by three statewide dental managed care plans. When you or your child enrolls in Texas Medicaid or CHIP, you will be assigned to one of these dental plans. Below is information about each plan, along with links to their member portals where you can find providers, view benefits, and access member resources.
MCNA Dental — Texas Medicaid and CHIP
MCNA Dental is one of the largest Medicaid and CHIP dental plans in the nation and serves the entire state of Texas. MCNA offers a large network of general dentists and dental specialists, member rewards including Amazon gift cards for preventive visits, and a toll-free Hygienist Helpline for after-hours dental questions.
Member Portal: mcnatx.net/members
Member Hotline: 1-855-691-6262
DentaQuest — Texas Medicaid and CHIP
DentaQuest serves over a million Texas Medicaid and CHIP dental members statewide. DentaQuest provides member rewards for preventive visits, a mobile app for managing benefits, and access to a broad network of dentists and specialists across all Texas communities.
Member Portal:
https://www.dentaquest.com/en/texas/members
Member Hotline: 1-800-516-0165 (Medicaid) |
1-800-508-6775 (CHIP)
UnitedHealthcare Dental — Texas Medicaid and CHIP
UHC Dental Plan serves the Texas Children’s Medicaid and CHIP program throughout the state, providing a large network of general dentists and dental specialists. UHC Dental covers a wide range of treatments and services for children from birth through age 20 under Medicaid.
Member Portal: dentaltx.uhc.com
Member Hotline: 1-877-901-7321
Important Texas Medicaid and CHIP Resources
The following links provide essential information for Texas families who have or are applying for Medicaid or CHIP dental coverage. We have compiled these resources so you have everything you need in one place.
Apply for Texas Medicaid or CHIP
Texas Health and Human Services — Medicaid & CHIP Overview
hhs.texas.gov/services/health/medicaid-chip
CHIP Program Information
hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/chip
Texas Health Steps (Dental for Children)
hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/texas-health-steps
Texas Medicaid Dental Policy Updates
tmhp.com (Texas Medicaid & Healthcare Partnership)
Medicaid/CHIP Enrollment Broker (Maximus)
Call 1-800-964-2777 (Mon–Fri, 8am–8pm CT)
2-1-1 Texas (Benefits Helpline)
Call 2-1-1, select option 2 for Medicaid/CHIP
Texas Health Steps Helpline
Call 1-877-847-8377 (1-877-THSTEPS)
InsureKidsNow.gov (Federal CHIP Resource)
Medicaid.gov — Dental Care Overview
medicaid.gov/medicaid/benefits/dental-care
If you need help navigating any of these resources or have questions about your family’s eligibility for Medicaid or CHIP dental coverage, our team is happy to help point you in the right direction. Call us at 210-361-2000.
Medicaid & CHIP Families — We Are Here for You
Lucent Orthodontics proudly accepts Medicaid and CHIP for qualifying orthodontic treatment. If you have been looking for an orthodontist in San Antonio who takes Medicaid, we welcome you and your family.
Call 210-361-2000 to schedule a free evaluation and find out if your child qualifies for Medicaid-covered braces.
To apply for Medicaid or CHIP, visit yourtexasbenefits.com or call 2-1-1.
CHIP — Children’s Health Insurance Program in Texas
The Children’s Health Insurance Program, known as CHIP, provides health coverage for uninsured children in Texas families who earn too much to qualify for Medicaid but cannot afford private insurance. CHIP includes dental benefits as a core part of its coverage, giving eligible children access to regular checkups, preventive care, and treatment for dental and gum conditions.
CHIP members choose one of the three statewide dental managed care plans — MCNA Dental, DentaQuest, or UnitedHealthcare Dental — to administer their child’s dental benefits. Benefits include exams, cleanings, X-rays, fillings, extractions, and other medically necessary dental services. CHIP does have an annual cap on dental services; if your child needs services beyond the cap, prior approval from the dental plan is required.
CHIP enrollment fees are $50 or less per family per year, with co-pays for covered services ranging from $3 to $5 for lower-income families and $20 to $35 for higher-income families depending on household income. These low costs make CHIP one of the most affordable ways for Texas families to access quality dental care for their children.
To apply for CHIP, visit yourtexasbenefits.com or call 2-1-1 and select option 2. Once enrolled, contact the Enrollment Broker at 1-800-964-2777 to choose your child’s dental plan.
While CHIP dental benefits cover a wide range of preventive and restorative services, orthodontic coverage under CHIP is limited and subject to specific criteria. Our team will help you understand what is and is not covered under your child’s plan during your free consultation.
Let’s Make Your Smile Affordable
152 Fairmont Parkway, Pasadena, TX, 775041
☎ Call 210-361-2000
✉ lucent@satxdentalgroup.com
Why Medicaid and CHIP Families Choose Lucent Orthodontics
We understand that families using Medicaid and CHIP sometimes feel like their options are limited, or worry that they will receive lesser care because of their insurance type. At Lucent Orthodontics, that is never the case.
Here is what you can expect when you bring your family to our office:
Same exceptional care for every patient — There is no difference in the quality of treatment, the technology we use, or the attention we give based on how your care is paid for. Every patient receives the same standard of clinical excellence from Dr. Shakourian, period.
A team that speaks your language — We understand Medicaid and CHIP. Our team is experienced in navigating the enrollment process, verifying benefits, submitting prior authorizations, and managing ongoing claims. We handle the complexity so you do not have to.
No judgment, only compassion — Our practice was built on the belief that orthodontic care should be accessible to every family. We treat Medicaid and CHIP families with the same respect, warmth, and genuine care that every patient at Lucent receives. You will always feel welcome here.
Transparent communication — Dr. Shakourian will give you an honest assessment of whether your child’s case qualifies for Medicaid coverage. If it does, we will walk you through the process step by step. If it does not, we will explain why and present affordable alternatives so your child can still receive the care they need.
A welcoming, family-friendly environment — Our office is designed to make every family feel comfortable and at home, from the moment you walk through the door to the day your child’s braces come off. We are here to support your entire family throughout the treatment journey.
Frequently Asked Questions — Medicaid and CHIP Orthodontic Care
Does Lucent Orthodontics accept Medicaid?
Yes. Lucent Orthodontics proudly accepts Texas Medicaid for qualifying orthodontic treatment. We work with all three Texas Medicaid dental managed care plans: MCNA Dental, DentaQuest, and UnitedHealthcare Dental.
Does Lucent Orthodontics accept CHIP?
Yes. We work with all three Texas CHIP dental managed care plans. CHIP dental benefits include a range of preventive and restorative services. Orthodontic coverage under CHIP is subject to specific clinical criteria, and our team will verify your child’s benefits during the free evaluation.
Does Texas Medicaid cover braces for my child?
Texas Medicaid may cover orthodontic treatment for children and young adults through age 20 when the case meets medical necessity criteria for severe handicapping malocclusion. Coverage is not available for cosmetic-only cases. Dr. Shakourian will evaluate your child and give you an honest determination of whether the case is likely to qualify.
What does “severe handicapping malocclusion” mean?
A severe handicapping malocclusion is a significant misalignment of the teeth or jaws that affects oral health, function, or development. This can include severe crowding that prevents teeth from erupting, significant overbites or underbites that impair chewing or speech, crossbites, cleft-related irregularities, and other conditions that go beyond a cosmetic concern.
Does Medicaid cover braces for adults in Texas?
Texas Medicaid orthodontic benefits under the Texas Health Steps program are available for children and young adults through age 20. Medicaid generally does not cover orthodontic treatment for adults over 20 in Texas. However, our flexible payment plans can make adult treatment affordable even without Medicaid coverage.
What is the difference between Medicaid and CHIP?
Medicaid provides free or low-cost health coverage for individuals and families with limited income who meet eligibility requirements. CHIP covers children in families that earn too much to qualify for Medicaid but cannot afford private insurance. Both programs include dental benefits for children in Texas, administered by the same three dental managed care plans.
How do I know which dental plan my child is enrolled in?
Your child’s dental plan (MCNA, DentaQuest, or UHC Dental) is listed on the Medicaid or CHIP card that was mailed to you at enrollment. If you are unsure, you can call the Enrollment Broker at 1-800-964-2777 or call 2-1-1 to confirm your child’s plan.
Do I need a referral from a dentist to schedule an orthodontic evaluation?
No. You can schedule a free orthodontic evaluation directly with Lucent Orthodontics without a referral. While many families are referred by their general dentist, a referral is not required to see us.
Is the orthodontic evaluation free for Medicaid and CHIP patients?
Yes. Your child’s initial orthodontic evaluation at Lucent Orthodontics is completely free, regardless of insurance type. There is no cost and no obligation.
What happens if my child’s Medicaid application for braces is denied?
If the prior authorization is denied, our team will explain the reason and discuss your options. In some cases, we may be able to appeal the decision with additional documentation. If the denial stands, we offer flexible, in-house payment plans that can make treatment affordable for your family even without Medicaid coverage.
How long does the Medicaid prior authorization process take?
Processing times vary by dental plan, but prior authorization decisions typically take a few weeks after submission. Our team monitors the status and follows up with the plan as needed. We will contact you as soon as we have a decision.
What conditions does Medicaid not cover for braces?
Texas Medicaid does not cover braces for cosmetic reasons. If a child’s teeth are only mildly crooked and the bite is functionally normal, the case will not meet the medical necessity threshold. Medicaid also does not typically cover cosmetic options like clear aligners unless they are medically justified and approved.
Can I choose which Medicaid dental plan my child is on?
Yes. When you enroll in Texas Medicaid or CHIP, you can choose your child’s dental plan by calling the Enrollment Broker (Maximus) at 1-800-964-2777. You can select from MCNA Dental, DentaQuest, or UnitedHealthcare Dental.
How do I apply for Medicaid or CHIP for my child?
You can apply online at yourtexasbenefits.com, call 2-1-1 and select option 2, or visit your local Texas Health and Human Services office. The application process covers both Medicaid and CHIP — the state determines which program your family qualifies for based on your household income.
What if my child has both Medicaid and another dental insurance plan?
If your child has Medicaid plus a secondary dental plan, our team can coordinate benefits between both to minimize your out-of-pocket costs. Bring all insurance information to your appointment and we will review everything for you.
Will my child receive the same quality of care as patients with private insurance?
Absolutely. Every patient at Lucent Orthodontics receives the same standard of clinical excellence, the same technology, the same personal attention, and the same compassionate care from Dr. Shakourian and our team, regardless of how treatment is paid for. We do not differentiate our care based on insurance type.
