Adult braces can serve more than cosmetic purposes. Many adults who opt for braces do so to help align their teeth and relieve pain caused by a bad bite. Florida’s Medicaid services may include coverage for certain oral evaluations and dental procedures if you qualify.

Understanding Medicaid Eligibility Groups in Florida

In Florida, the Agency for Health Care Administration manages the state’s Medicaid program through the Department of Children and Families (DCF) for most eligibility groups. The Social Security Administration administers and manages eligibility for Supplemental Security Income (SSI) recipients.

DCF categorizes eligibility for Medicaid recipients into the following groups:

  • Family-related Medicaid. This category includes parents and caretakers of eligible children, pregnant women, children under the age of 19, young adults up to age 21 and former foster care children between the ages of 18-26.
  • Emergency Medical Assistance (EMA) for non-citizen applicants. This provides coverage to non-citizens for serious medical needs that a medical professional proves qualifies as an emergency. The individual would need to qualify for Medicaid based on all other requirements aside from citizenship in order to receive this coverage.
  • Medically Needy (Share of Cost). Any applicant who cannot qualify for Medicaid services because their income or assets exceed the limits Florida sets for its Medicaid program may be enrolled in this program. The share of cost amount depends on several financial factors, but once the applicant meets their share of cost requirements, they receive Medicaid services for the rest of that month.
  • Medicaid for Aged or Disabled. Applicants aged 65 and older or applicants under the age of 65 who have qualifying disabilities may be eligible for Medicaid coverage in Florida. If these applicants are also Medicare beneficiaries, Medicaid may be offered based on full or partial eligibility rules. Partial eligibility may provide assistance for paying certain Medicare premiums for Part A or Part B or prescription drug costs with the Part D plan.

Dental Coverage for Dual-Eligibles in Florida

Dental benefits are an optional service with Medicaid, so each state determines what services they offer to different eligibility groups. Currently, Florida’s dental coverage for adults aged 21 and older does not include braces or other orthodontic work. Policies related to coverage limits can change from one year to the next, which means recipients should keep themselves up-to-date in case new services are included or established ones are eliminated.

Services that are available to adults over the age of 21 can include exams, x-rays, screenings and consultations that may allow recipients to evaluate their need for or potential benefit from braces. Dual-eligibles, or recipients who receive some Medicaid benefits through a Medicare-related program, may not qualify for dental coverage in Florida.

Enrollment in a Medicare Advantage plan may be possible for dual-eligibles who do not qualify for dental coverage through Medicaid. These plans are sold by private insurers contracted with Medicare to provide Part A and Part B coverage, but many Medicare Advantage plans offer additional benefits. These extras can include coverage for certain oral health procedures, but benefits can differ between each insurer and plan.

You should always check with your state’s eligibility determination agency to verify whether you can still qualify for Medicaid-related benefits if you also receive services through a Medicare Advantage plan.

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