In 2010, Texas dentists collected $185 million in Medicaid reimbursement for orthodontic services -- more than the rest of the U.S. combined.
While the state is now taking steps to strengthen its authorization process for orthodontic braces, an investigative report by WFAA-TV in Dallas found that Texas taxpayers didn't just pay orthodontists for those services, they also spent $13 million on orthodontic transportation for kids participating in the state's Medicaid orthodontics program.
Children got picked up, taken to orthodontists' offices, had their braces installed or worked on, and were taken home again, according to WFAA-TV. Medicaid pays for up to 26 trips per patient, the report noted.
The Texas Health and Human Services Commission is now taking several steps to tighten the enforcement of Medicaid dental policies:
Affiliated Computer Services, the contractor responsible for approving requests for orthodontic services, has been directed to develop a corrective action plan to ensure that existing state policies are followed. Those policies limit orthodontic services to cases where it is medically necessary. State policies do not cover orthodontic care for cosmetic reasons.
On October 1, the state will begin requiring full-cast dental molds to be submitted with all requests for braces. This is in addition to the x-rays, photos, and other documentation already required.
The state has begun pulling hundreds of cases to review the contractor's approval process for braces. The state will sample new cases each quarter to review the work of each staff member processing requests for services.
The state Office of Inspector General is continuing its review of the authorization process for orthodontic services.
