OHP Orthodontic Benefit
Eight months into the expanded OHP orthodontic benefit, more kids are being approved for orthodontic treatment.
On January 1, 2023, the OHP orthodontic benefit expanded to include those under age 21 with handicapping malocclusion. Now, 8 months into the benefit expansion, there has been an increase in orthodontic approvals over prior years. Many thanks to the orthodontic primary dental provider champions at Neighborhood Health Center and Wallace Dental Clinics for their orthodontic referrals, all of which have been approved. Thanks also to the other clinics who have screened patients and submitted orthodontic referrals.
We know that there are other kids in our network who may qualify. Considering how life-changing orthodontics could be for these kids, we encourage primary dental providers to look out for patients under age 21 who might meet the criteria for orthodontic services.
In addition to being free and clear of decay and periodontal disease as documented by a comprehensive or periodic exam within the prior 6 months prior to referral, kids must also have an automatic qualifying condition or a score of 26 or greater on the Handicapping Labio-Lingual Deviation (HLD) Index California Modification Score Sheet. Conditions that automatically qualify are:
- Cleft palate, cleft lip with alveolar process involvement, craniofacial anomalies resulting in significant malocclusion expected to result in difficulty with mastication, speech, or other oral function
- Deep impinging overbite when lower incisors are destroying the soft tissue of the palate
- Crossbite of individual anterior teeth when clinical attachment loss and recession of the gingival margin are present
- Severe traumatic deviation (e.g., loss of a premaxilla segment by burns or by accident; the result of osteomyelitis; or other gross pathology)
- Overjet >9 mm with incompetent lips and masticatory and speech difficulties
- Reverse overjet >3.5 mm with masticatory and speech difficulties
Orthodontic referrals require submission of specific documentation and records in order to be considered for approval. CareOregon Dental created a Toolkit that delineates these requirements and provides a guide for submission of these referrals. This Toolkit has been distributed to CareOregon Dental’s network primary dental clinic dental directors. For more information, primary dental providers should contact their clinic’s dental director. Other providers can contact the Dental Access Team at firstname.lastname@example.org.