Does MCNA Dental Cover Braces in Texas? Medicaid and CHIP Rules
Reviewed October 14, 2026. Yes, MCNA Dental can cover braces in Texas, but only for Texas Medicaid members 20 and younger whose orthodontic treatment is medically necessary and approved in advance. Braces for cosmetic reasons or minor crowding usually aren’t approved. CHIP dental plans, including MCNA’s, don’t cover orthodontics, and adults 21 and older aren’t in MCNA’s Texas children’s program.
Quick answer: Texas Health Steps (children’s Medicaid) covers orthodontics such as cleft palate correction and crossbite therapy, and prior authorization is needed. Since October 1, 2024, Texas uses three levels of orthodontic treatment with specific criteria and records. Your child’s MCNA orthodontist sends the request to MCNA; standard decisions take about 3 business days. Questions? Call the MCNA Texas Member Hotline at 1-855-691-6262 (TTY 711).
Who MCNA Dental covers in Texas
MCNA (Managed Care of North America) Dental is one of the dental plans for Texas Medicaid and CHIP children. Texas HHSC names DentaQuest and MCNA as the dental managed care organizations for CHIP dental. (HHSC Texas Works Handbook D-1750) Most Medicaid clients 20 and younger get dental care through a dental plan; Medicaid clients 21 and older, people living in institutions and STAR Health members are handled differently. (TMHP Managed Care Handbook)
HHSC’s procurement forecast lists a new Medicaid and CHIP dental services procurement (RFP HHS0017108) expected to post in state fiscal year 2027. No new dental plans or start dates have been announced, so MCNA members keep their current plan for now. (HHSC procurement forecast)
Does Texas Medicaid cover braces?
Yes, when they’re medically necessary. HHSC’s Texas Health Steps dental page lists orthodontic services, including correction of cleft palate and crossbite therapy, for clients 20 and younger, and says prior authorization is needed. (HHSC: Texas Health Steps dental)
The three levels of orthodontic treatment
Starting October 1, 2024, Texas Health Steps orthodontic benefits were organized into three levels. (TMHP, August 16, 2024)
| Level | What it treats | What’s needed |
|---|---|---|
| Level I (limited treatment) | Certain front or back crossbites | Prior authorization, X-rays, photos, treatment plan and a narrative of medical necessity |
| Level II (comprehensive) | Evidence of at least 4 of 9 conditions, such as overbite over 5 mm, overjet over 8 mm, lower crowding over 6 mm, full-cusp Class II or III bite, or impacted canines | Prior authorization plus digital or 3D models and a cephalometric X-ray with tracing |
| Level III (comprehensive, severe) | Evidence of at least 4 of 10 conditions, such as open bite over 6 mm, impacted front teeth or severe crossbites | Same as Level II |
You may still see the older Handicapping Labio-Lingual Deviation (HLD) score sheet, which set a minimum of 26 points, online. Ask your orthodontist which criteria MCNA is applying to your child’s request today. (TMHP HLD form)
2026 rule: in-person exam first
Since March 1, 2026, Texas Medicaid rules say orthodontic treatment can’t begin until a licensed dentist has examined the patient in person and reviewed diagnostic images, with added record-keeping and counseling requirements. (TMHP, December 29, 2025) Mail-order aligners without an in-person exam won’t qualify.
Does CHIP cover braces in Texas?
No. Texas CHIP’s dental summary says orthodontics is not a dental plan benefit for CHIP. Limited orthodontic care may be available through the CHIP medical plan in specific cases, such as craniofacial anomalies related to surgery. All CHIP children do get dental benefits, with dental copays of $5, $20 or $25 depending on income. (InsureKidsNow: Texas CHIP dental)
How to get braces approved with MCNA
- Get a dental exam. Your child’s main dentist can refer you to an orthodontist who takes MCNA. Find one with MCNA’s provider locator.
- Orthodontic evaluation and records. The orthodontist takes the X-rays, photos and models needed for the level being requested.
- Prior authorization. The orthodontist submits the request to MCNA through MCNA’s portal or by fax. Standard decisions take about 3 business days; if information is missing, the provider has 10 business days to send it. (MCNA Texas prior authorizations)
- Start within a year. An approval is valid for one year; if treatment doesn’t start in that time, a new request is needed.
- Keep coverage active. Renew Medicaid on time. If your child turns 21 or loses eligibility mid-treatment, Texas rules say the dental plan must finish a course of orthodontic treatment already underway, unless the member was disenrolled for cause. (TMHP)
Tips to improve the chance of approval
- Choose an in-network orthodontist. Confirm the office takes MCNA Texas Medicaid for orthodontics, not only for general dentistry.
- Ask which level is being requested (Level I, II or III) and which of the listed conditions the orthodontist documented.
- Keep copies of the denial or approval letter, because appeal deadlines run from the date on the letter.
- Ask about other medical needs. If your child has a cleft palate or another craniofacial condition, tell the orthodontist; these cases have their own rules and may qualify for more than one course of treatment.
- Keep Medicaid active. Answer renewal notices from HHSC quickly so treatment isn’t interrupted. See our Medicaid renewal guide.
If MCNA denies braces
- Appeal to MCNA: MCNA resolves standard appeals in 30 days and emergency appeals in 3 days.
- External Medical Review (Medicaid): request within 120 days of MCNA’s decision letter.
- State Fair Hearing (Medicaid): request within 120 days of the original decision letter, after MCNA’s appeal process is finished.
- CHIP: request an Independent Review Organization review within 120 days; CHIP complaints can also go to the Texas Department of Insurance at 1-800-252-3439.
(MCNA Texas complaints and appeals) For help, call the HHS Office of the Ombudsman managed care help line at 866-566-8989. (HHSC Ombudsman) To change dental plans, call the Texas enrollment broker at 1-800-964-2777. (HHSC: Choosing a health plan)
What else MCNA Texas covers
Beyond orthodontics, MCNA Texas members get Texas Health Steps checkups, cleanings, X-rays, sealants, fluoride, fillings and other medically necessary care. MCNA also lists value-added services such as a $20 Amazon gift card per child (restrictions apply), an after-hours helpline staffed by dental hygienists, a “My First Toothbrush” kit, and a backpack and book for ages 4 to 6. (MCNA Texas members) For adults, see what MCNA Dental covers for adults; to find a local office, see Medicaid dentists in Tyler, Texas.
Braces for adults with Medicaid or Medicare
Texas Medicaid adults 21+ aren’t in MCNA’s children’s program, and orthodontics for adults generally isn’t covered. Medicare doesn’t cover braces either; see does Medicare cover orthodontics. If you have both Medicare and Medicaid, compare dental extras in 2027 plans with our Medicaid vs Medicare guide, and check whether you qualify with our Medicaid eligibility tool.
Frequently asked questions
Does MCNA Dental cover braces in Texas?
Yes, for Medicaid members 20 and younger when treatment meets Texas Health Steps criteria and MCNA approves it in advance. Not for CHIP members or for cosmetic reasons.
What does MCNA Dental cover?
Checkups, cleanings, X-rays, sealants, fluoride, fillings and other medically necessary dental care for Texas Medicaid and CHIP children, plus value-added extras listed on MCNA’s site.
How long does MCNA take to approve braces?
MCNA says standard prior authorization decisions take about 3 business days once it has the information it needs.
How do I find an MCNA dentist or orthodontist?
Use locator.mcna.net or call the MCNA Texas Member Hotline at 1-855-691-6262, Monday to Friday, 7 a.m. to 7 p.m. Central.
Can my teen finish braces after turning 21?
Yes, if treatment already started. Texas rules require the dental plan to finish a course of orthodontic treatment underway when a member ages out, unless disenrolled for cause.
This article is general information. Medicare365 is not affiliated with or endorsed by MCNA Dental, Texas HHSC or any U.S. government agency. Rules can change; confirm coverage with MCNA before treatment.