The Effect of Illinois Medicaid Managed Care On Orthodontic Coverage (Dental Braces)

Early this year, Illinois has switched close to 1.5 million of its Medicaid recipients into managed care delivery system. Illinois officials believe that managed care will improve health care delivery for Medicaid patients and help to reduce state spending on Medicare programs.

Medicaid recipients have been receiving letters notifying them to choose among several managed care plans. If the recipients don’t pick a plan within sixty days of receiving a letter, they will be automatically enrolled into a plan chosen by Medicaid. The choice of plans varies by county and city where the recipients reside. In some areas patients have a choice of more than ten plans. The most common plans for Cook county are IlliniCare Health Plan , Blue Cross Blue Shield of Illinois, Cigna Health Spring of Illinois, Community Care Alliance if Illinois (CCAI), Humana Health Plan, Meridian, and Aetna Better Health

Among services affected by managed care shift is orthodontic treatment (braces) for children on Medicaid and All Kids program. Qualification for orthodontic coverage and treatment delivery varies among managed care plans and can be confusing for patients not familiar with the changes. Most of the plans do provide some coverage for orthodontic treatment (braces) to recipients under the age of 21, however qualification criteria and approval process may vary. Once the patient is approved by orthodontic treatment by a specific plan, it’s strongly recommended that the patient maintains coverage under that plan until completion of orthodontic treatment. Switching plans during orthodontic treatment may cause loss of orthodontic benefits, need to switch providers and delays in treatment.

Patients should visit Medicaid (All Kids) contracted orthodontist for a consultation and more information about orthodontic coverage and approval process. To schedule an orthodontic consultation, please contact Orthodontic Experts of Arlington Heights (847)749-4340 or Orthodontic Experts in Chicago (773)801-7171. More details about orthodontic coverage with Public Aid (All Kids, Medical Card, Medicaid) is available on http://www.publicaidbraces.com