Does TennCare Cover Braces? Qualifying, Approval, and Denials

TennCare does cover braces, but only for members under 21 and only when the orthodontic work is medically necessary to correct a “handicapping malocclusion.” Braces meant to straighten teeth or improve a smile are treated as cosmetic and are not paid for. Adults on TennCare have no orthodontic coverage at all, even though adult dental benefits began in January 2023.¹

Who Qualifies

Orthodontic coverage follows the federal Early and Periodic Screening, Diagnostic, and Treatment rule, which requires state Medicaid programs to provide medically necessary orthodontic services to children.² In Tennessee, that means the member must be under 21 and the dental condition has to be causing a real functional problem, not just an uneven bite.

The TennCare Policy Manual recognizes three qualifying conditions:³

A nutritional deficiency caused by teeth that make eating difficult, documented by a qualified physician, where the deficiency has not responded to medical treatment alone.
A speech impediment linked to the teeth, documented by a qualified speech therapist, that has not improved with speech therapy.
Soft tissue laceration from a deep impinging overbite, documented by the treating orthodontist. Occasional cheek biting does not count.

Craniofacial conditions such as cleft palate, hemifacial microsomia, and mandibulofacial dysostosis are listed as examples of handicapping malocclusions, but even these still go through prior authorization and must meet the medical necessity criteria.⁴ The Children Dental Plan handbook also notes that treatment and devices to correct craniofacial anomalies may be covered as an emergency service.⁵

If a dentist’s only reason for recommending braces is to straighten teeth or improve appearance, TennCare classifies that as cosmetic and will not pay.¹

How Approval Works

Approval has to come before the braces go on. The process is now managed by Renaissance, which took over as TennCare’s dental benefits manager on November 1, 2025.⁶

The child first needs a referral from their primary dentist to an orthodontist in the TennCare network.⁵ Before any prior authorization request can go in, the qualifying condition must already be documented by the right professional. A speech impediment, for instance, needs to be in a speech therapist’s progress notes, with records showing therapy alone did not resolve it.³ A parent’s description of the problem is not enough; every condition needs clinical documentation in the file.⁷

TennCare also uses a scoring tool called the Malocclusion Severity Assessment to gauge how severe the condition is. A score of 28 or higher, as evaluated by a dentist reviewer for the dental benefits manager, meets the threshold for medical necessity. The regulations are explicit that an MSA score alone cannot be the sole basis for a denial.⁴

Once the documentation is complete, the orthodontist submits the prior authorization request. According to one provider practice, decisions generally come back within two to four weeks. If approved, TennCare pays for the full course of treatment, including retainers that come with the original case. Replacement retainers are not covered.⁸

Treatment must generally be done by an orthodontist or by a pediatric dentist with specialty training in orthodontics. In areas with a specialist shortage, a general dentist who has completed an ADA-accredited orthodontic program may be authorized case by case, with sign-off from the dental benefits manager and the TennCare Dental Director.³

If You Get a Denial

Denials are common. A written denial letter will explain the decision, and members have 60 days from the date on that letter to appeal.⁹

Start by calling Renaissance customer service at 866-864-2526 to see if the issue can be fixed informally. If it cannot, file a formal appeal with TennCare Member Medical Appeals: call 800-878-3192, mail PO Box 593, Nashville, TN 37202-0593, email TMMA.Contact.Center@tn.gov, or fax 888-345-5575. Standard appeals are typically decided within 90 days. If waiting that long could endanger the child’s health, the treating provider can request an expedited appeal, which is decided in roughly one week.¹⁰

Emily Jenkins, director of the Healthcare Justice Clinic at the Tennessee Justice Center, said many denials come from technical problems like unreadable dental scans or insufficient language in the medical documentation, and that denial notices are often too vague for families to understand what to fix. If the child is in foster care, the Department of Children’s Services can help with the appeal. Foster families can call DCS customer relations at 800-861-1935 or email DCS.Custsrv@tn.gov.⁷

Finding an Orthodontist Who Takes TennCare

Approval does not guarantee a quick start. Few orthodontists and pediatric dentists participate in the TennCare network, and waiting lists are common. Some practices add their own age restrictions because of the backlog; at least one Tennessee practice will not see TennCare patients under age 12 for braces due to limitations in the approval process.⁸

To find an in-network provider, use the Renaissance “Find a Dentist” tool, which has separate searches for the TennCare Children, CoverKids, and TennCare Adult plans.¹¹ Members can also log into the Renaissance Member Portal or call 866-864-2526 for help.⁵

CoverKids Follows the Same Rule, With One Difference

Tennessee’s separate Children’s Health Insurance Program, CoverKids, also covers braces when they are medically necessary. CoverKids adds one requirement TennCare does not: the child must have one year of continuous enrollment before becoming eligible for orthodontic services.¹² As of January 2025, CoverKids no longer has a lifetime orthodontic maximum, and families owe no out-of-pocket costs for approved treatment.¹³

Adults and the 21st Birthday Cutoff

TennCare adult dental benefits began in January 2023 and cover services like cleanings, fillings, crowns, extractions, root canals, dentures, and oral cancer screenings. Orthodontics is not on the list. The official schedule of 90 covered adult dental procedure codes contains no entries for braces, aligners, or retainers.¹⁴

For a child whose treatment is approved and underway, coverage ends on the 21st birthday. Any remaining treatment after that point is no longer reimbursed, and the family becomes responsible for the balance at the provider’s contracted price.³ The same thing happens if the child loses TennCare eligibility mid-treatment.⁸

If TennCare Will Not Pay

Families whose children do not qualify, or whose appeals fail, have a couple of nonprofit options. Tennessee Kids Belong recruits orthodontists who offer discounted services to children in foster care, and foster families can locate participating providers through its Foster Friendly app.⁷

Smiles Change Lives partners with foster care agencies to provide orthodontic care at reduced cost. Children ages 7 to 18 with moderate to severe orthodontic need, good oral hygiene, and no unfilled cavities may qualify. The program charges a $30 application fee and a $650 financial investment per child, with no proof of income required for foster care applicants. The child must be in a long-term placement, since treatment typically takes two to three years to finish.¹⁵

1
TN.gov. TennCare Dental Services
2
Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment
3
TN.gov. TennCare Policy Manual, Policy No. PRO 05-001
4
Tennessee Secretary of State. Tenn. Comp. R. & Regs. 1200-13-13-.04
5
Renaissance Benefits. TennCare Children Dental Plan Member Handbook
6
TN.gov. TennCare Dental Benefits Manager
7
The Tennessean. TennCare Braces Coverage
8
Foothills Pediatric Dentistry and Orthodontics. Medicaid TennCare
9
Renaissance Benefits. TennCare Adult Dental Plan Member Handbook
10
TN.gov. How To File a Medical Appeal
11
Renaissance Benefits. Find a Dentist
12
TN.gov. CoverKids Frequently Asked Questions
13
DentaQuest. CoverKids Member Handbook
14
TN.gov. Adult Dental Covered Codes
15
Smiles Change Lives. Foster Care Families