If you’re a parent in the Tri-Cities wondering whether Washington’s Medicaid program will cover braces for your child, you’re asking one of the most important questions we hear at our office, and the short answer is yes, it can. Washington’s Medicaid program, called Apple Health, does cover orthodontic treatment for children who meet specific medical-necessity criteria. At Andros Orthodontics, we proudly accept Apple Health for qualifying cases, ages 20 and under, and our team has walked hundreds of Tri-Cities families through the approval process. This guide will help you understand exactly how Medicaid covers braces in Washington, who qualifies, and how to get started.
Does Medicaid Cover Braces in Washington State?
Yes. Washington Apple Health (the state’s Medicaid program) covers orthodontic treatment, including traditional braces, for eligible children under 21. Coverage is not automatic, though. Orthodontics through Apple Health is considered a medically necessary service, which means your child’s bite, jaw alignment, or tooth position needs to meet specific severity criteria set by the state. If your child qualifies, Apple Health typically covers the full cost of treatment, including records, braces, adjustments, and retainers.
For families across Pasco, Kennewick, and Richland, this can be life-changing. A full course of orthodontic treatment is a real expense, and for a lot of families it’s simply out of reach without help. Medicaid coverage opens the door to the same high-quality, board-certified orthodontic care we provide to every patient who walks through our doors — and when a case is approved, treatment is covered in full. The family pays $0.
Who Qualifies for Medicaid Orthodontic Coverage in Washington?
To qualify for orthodontic coverage through Apple Health, two things need to line up:
- Your child must be enrolled in Washington Apple Health. Most kids under 19 in low- or middle-income households qualify, and many young adults up to age 21 are eligible too. If you’re not sure whether you’re enrolled, you can check at hca.wa.gov or give our front desk a call. We help families figure this out every week.
- Your child’s orthodontic case must meet medical-necessity criteria. Washington uses a scoring tool called the Handicapping Labio-Lingual Deviation (HLD) Index to measure the severity of a bite or alignment issue. Cases involving significant overbites, underbites, crossbites, crowding, impacted teeth, or jaw problems often qualify. Purely cosmetic concerns generally don’t.
The good news: you don’t have to figure out the HLD score on your own. That’s our job. During a free consultation, Dr. Andros personally evaluates your child, takes the necessary records, and submits everything to Apple Health for prior authorization. If the case qualifies, we handle the paperwork from there.
What Does Apple Health Cover (And What It Doesn’t)
When Apple Health approves orthodontic treatment, coverage is generous. Approved cases typically include the initial exam and diagnostic records, the braces themselves, every routine adjustment visit, emergency visits for loose brackets or poking wires, and retainers after treatment. For an approved case, that’s the entire cost of treatment — the family pays $0.
A few things to keep in mind:
- Apple Health usually covers traditional metal braces. Clear aligners like Invisalign and clear ceramic braces aren’t typically covered, though families can sometimes pay the difference to upgrade. We’ll walk you through your options.
- Coverage is generally for children and young adults up to age 21. Adult orthodontic coverage through Medicaid is very limited in Washington.
- Approvals are case-by-case. If your child’s case doesn’t score high enough for medical necessity on the first submission, there are sometimes ways to strengthen the request, or we can discuss affordable payment plans so cost doesn’t stand in the way.
How the Process Works at Andros Orthodontics
We’ve tried to make the Medicaid orthodontics process as painless as possible for Tri-Cities families. Here’s what it looks like when you come see us:
- Step 1: Free consultation. We’ll see you and your child at no cost and with no obligation. Dr. Andros does a full exam, we take X-rays and photos, and we talk through what treatment would look like.
- Step 2: We submit the prior authorization. Our team handles the paperwork, the HLD scoring, and communication with Apple Health. You don’t have to chase anything down.
- Step 3: Approval (usually 2–6 weeks). Once we hear back, we’ll call you with the result and schedule your child’s placement appointment.
- Step 4: Treatment begins. From braces day through the final retainer, you’re part of the Andros family. We see patients roughly every 6–8 weeks, and we always have someone on our bilingual English/Spanish team ready to answer your questions.
Our whole team speaks Spanish and English fluently, so Spanish-speaking families in the Tri-Cities never have to navigate this alone. Hablamos español, y estamos aquí para ayudar a tu familia.
What If My Child Doesn’t Qualify?
If Apple Health doesn’t approve your child’s case, that doesn’t mean treatment is off the table. You can choose to move forward as a private-pay patient: we offer in-house payment plans with no credit check and interest-free financing available, and we’ll work with you to find a monthly number that fits your budget — most families land around $150 to $200 a month. Many families are surprised to learn that braces at our practice can start at around the cost of a cell phone bill when spread across the treatment period. The goal is always the same: getting your child the smile and bite they deserve, without the financial stress.
Ready to Find Out if Your Child Qualifies?
Finding out whether your child qualifies for Medicaid-covered braces in the Tri-Cities is easy, and it starts with a free consultation with our team. Dr. Nicholas Andros is board-certified by the American Board of Orthodontics with more than 12 years of experience serving Pasco, Kennewick, and Richland families, and we’ve helped hundreds of Apple Health patients start treatment.
Call us at (509) 792-1008 or book your free consultation online. We’ll let you know quickly whether Apple Health is likely to cover your child’s case, and either way, we’ll give you a clear path forward.
Andros Orthodontics: proudly serving the Tri-Cities community with board-certified orthodontic care, bilingual service, and an unwavering commitment to every smile that walks through our door.