Orthodontist Accepting DSHS in Texas: Medicaid/CHIP Coverage & How to Find Providers

DSHS (Texas Department of State Health Services) administers Texas Health Steps (Medicaid for children) and CHIP. Orthodontic coverage is limited.

Coverage Rules

• Medically Necessary Only: Severe malocclusion (HLD index ≥26), cleft palate, craniofacial anomalies, trauma.
• Cosmetic Orthodontics: Not covered.
• Age Limit: Typically up to age 20 (Medicaid) or 18 (CHIP).
• Prior Authorization Required: Orthodontist submits records, photos, models, HLD score.

Finding a Participating Orthodontist

1. TMHP Provider Search: tmhp.com → Provider Lookup → Specialty: Orthodontist.
2. Call DSHS / 2-1-1 Texas: For current provider lists.
3. Ask Orthodontist Offices Directly: "Do you accept Texas Medicaid/CHIP for comprehensive orthodontics?"
4. Dental Schools: UT Houston, Texas A&M, UT San Antonio — often accept Medicaid.

If Denied

• Request fair hearing (Medicaid) or appeal (CHIP).
• Document functional impairment (speech, chewing, psychosocial).

Network participation varies; verify before each appointment.