Orthodontia Program
0600-506.15 | Revision Date: 1/17/2024

Overview

This policy guide outlines the DCFS Countywide Orthodontia Services Program for DCFS-served children and provides guidelines on how to access funding for orthodontia services.

Table of Contents

Version Summary

This new policy guide was developed to provide procedures on how to access funding for orthodontia treatment for children, youth, and nonminor dependents (NMDs) in out-of-home care.

POLICY

Orthodontia Program

The Department of Children and Family Services (DCFS) Orthodontia Services Program, which is overseen by the Child Welfare Health Services Section under the Bureau of Clinical Resources and Services, provides guidelines for access to orthodontia services in a timely manner to children/youth/NMDs who have this identified special need. Orthodontia services include braces, retainers, and spacers to correct the alignment of teeth or repositioning of the jaws. Tooth extraction (except when deemed by the orthodontist as a necessary component of the orthodontia treatment) and dental implants are not considered part of orthodontia services.

The guidelines focus on utilizing external funding sources through Medi-Cal that are managed by the California Department of Health Services whenever those funds are determined to be available and appropriate to meet the orthodontia treatment needs of individual children/youth/NMDs. The funding resources for orthodontia treatment are listed below.

CSWs do not make the funding source determination. Providers take the initial steps to access external funding, and if those cannot be utilized, the Orthodontia Program staff provide guidance on how to access orthodontia funding.

A parent/legal guardian may consent to the child/youth/NMD’s orthodontia treatment unless their rights have been limited or termination of parental rights has occurred.

  • If a parent/legal guardian holds consent rights and refuses/declines to consent or is unable to be located for the child/youth’s orthodontia treatment, the CSW is to consult with County Counsel for the appropriate next steps to obtain a court order for such treatment.
  • If parental rights are terminated and court has not granted medical decision-making rights to the child’s caregivers, the CSW should consult with their County Counsel on how to obtain a court order authorizing orthodontia treatment.
  • If pursuing a court order to grant consent for orthodontia treatment, the language must include: “DCFS recommends for the court to authorize orthodontia treatment for (child’s name).”

An NMD may consent to their own orthodontia treatment by signing their name on the DCFS letterhead template, which is provided to the CSW by the Orthodontia Services Coordinator.

In instances where there are co-educational/developmental rights holders, the person who is eligible and available to sign the consent may sign the consent letter.  

The child/youth’s attorney cannot provide consent for orthodontia treatment.

Eligible Placements

The following placements are eligible for orthodontia funding:

  • Resource Family Home [This includes paid placements with relatives and Non Relative Extended Family Members (NREFM), as well as Approved Relative Caregivers (ARC)]
  • Small Family Home
  • Supervised Independent Living Program (SILP)
  • Non-relative/relative legal guardian home
  • Adoptive placement receiving Adoption Assistance Payment (AAP)
    • Please note, adoptions should not be finalized and jurisdiction should not be terminated prior to orthodontia funding being approved. Orthodontia treatment does not have to be completed prior to finalization.

Out-of-State Placements

For children/youth/NMDs who are placed out-of-state and under Los Angeles County’s jurisdiction, if an Interstate Compact on the Placement of Children (ICPC) social worker is assigned to serve the case out-of-state, they are to be contacted to determine the equivalent to Denti-Cal, Early and Periodic Screening, Diagnosis and Treatment Supplemental Services (EPSDT SS), or California Children’s Services (CCS), in the state where the child/youth/NMD is placed, and to determine the child’s/youth’s eligibility for the available orthodontia funding resource(s). If it is determined that the child/youth is not eligible for out of state funding resources, other funding options are to be considered by the Department.

Funding Sources

Denti-Cal

When an orthodontia provider determines that the child/youth/NMD may benefit from orthodontia treatment, the provider is to explore if they can bill to Denti-Cal (a dental component of Medi-Cal). Please note that the provider must be able to accept Medi-Cal patients. The CSW does not have to complete any forms if the provider is billing to Denti-Cal.

If the orthodontia provider indicated that the orthodontia treatment is not billable to Denti-Cal, the DCFS Orthodontia Program will assist in making a determination for eligibility of internal/DCFS-funded resources and/or provide guidance on how to access funding for a child/youth/NMD in out-of-home care.

A child/youth/NMD is not eligible for internal funding resources except in circumstances in which the Court has ordered DCFS to explore funding options for the child’s/youth/NMDs orthodontia treatment.  The three (3) internal funding resources are:

  1. Specialized Care Incentive and Assistance Program (SCIAP)
  2. Service Funded Activities (SFA)
  3. Supportive Therapeutic Options Program (STOP) Funds

Specialized Care Incentive and Assistance Program (SCIAP)

The DCFS Orthodontia Program will make a determination whether the youth/NMD is eligible for SCIAP funding based on the placement type. The Orthodontia Program SCIAP funds may only be utilized if the youth/NMD is denied from Denti-Cal or has a score lower than 26 on the Handicapping Labio-Lingual Deviation (HLD) Index scoring sheet. Please note that the maximum allowance for SCIAP funding is $4,999. Almost all Denti-Cal providers are able to provide orthodontia treatment at or below $4,999.

It is critical that if the child/youth/NMD has been assessed by a provider to need orthodontia treatment, the funding request and approval for orthodontia funding must occur prior to finalizing the adoption or closing out the case (termination of jurisdiction). The approval timeline can take up to 8 weeks to gather the requested documents and process the paperwork. Once an adoption is finalized and/or the case is closed, the child/youth/NMD is not eligible for internal funding resources. It is important that the assigned CSW and Adoptions CSW communicate to ensure that cases are not closed before orthodontia funding is approved.

For adoption cases, it is important to note the following:

  • An adoptive family is not eligible for SCIAP funds for a child/youth/NMD’s orthodontia treatment after the adoption is finalized. Therefore, it is important to identify the child/youth’s need for orthodontia treatment prior to finalizing an adoption to the extent possible. 
  • A child/youth/NMD is eligible for SCIAP funds if the child/youth is placed with a prospective adoptive family receiving AAP and the adoption has not been finalized.
  • Once SCIAP funding is approved, payment will continue for the duration of the scheduled treatment (even if adoption finalizes or the youth is no longer in an eligible placement).

If the child/youth/NMD does not qualify for SCIAP funds as determined by the Orthodontia Program, and if there is a court order for the Department to explore funding options for the child/youth/NMD’s orthodontia treatment, the assigned Orthodontia Services Coordinator will communicate with the CSW regarding Other Funding Sources.

Other Funding Sources

If the child/youth/NMD does not qualify for SCIAP funds, the Orthodontia Services Coordinator will provide information on possible funding through Service-Funded Activities (SFA) or Supportive Therapeutic Options Program (STOP). If there is a Juvenile court order for DCFS to pay for the child/youth/NMD’s orthodontia treatment, the CSW can pursue SFA funds. Specific instructions for SFA funds are provided in the SFA Policy. SFA funding eligibility is determined by the Special Payments Unit. The minute order/attorney order is to contain language such as:

  • “DCFS to explore possible funding for the (youth’s name) orthodontia treatment.”

STOP funds may only be requested as a last resort, in circumstances with no court involvement or no court order, and a child has been identified to need orthodontia treatment. Please refer to the STOP Unit’s website for specific conditions and procedures.

PROCEDURE

Referring Children/Youth/NMD in Out of Home Care for Orthodontia Services

Upon completion of the referral process below, the Orthodontia Program staff will determine if a child/youth/NMD is eligible for SCIAP funds. They will inform the CSW of the eligibility and any required documents, if missing. Once all of the documents are received, the Orthodontia Program staff will send the Payment Request for the Orthodontia Service Provider with the program manager’s signature and the signed DCFS 5540 along with the required documents to the Special Payments Unit: SpecialPaymentRequests@dcfs.lacounty.gov. A Special Payments Unit staff member will be assigned. They will send a Letter of Intent to the orthodontia treatment provider and provide a copy to the CSW. The provider may proceed with the orthodontia treatment upon receipt of the Letter of Intent.

CSW Responsibilities

  1. Complete the 001-04, Orthodontia Referral form.
    • This form is required to initiate the referral. All other required documents may be submitted subsequently, as determined by the Orthodontia Program staff. The process typically takes about 4-8 weeks, depending on how much time is needed for the CSW to gather the necessary documents.
  2. Submit the following required documents to the DCFS Child Welfare Health Services Section, Orthodontia Program via email at: DCFSOrthoProgram@dcfs.lacounty.gov:
    • Ortho Referral form 001-04
    • An orthodontia evaluation letter from the orthodontist which includes:
      • Name and license number of the orthodontist
      • Child/youth/NMD’s diagnosis
      • Child/youth/NMD’s treatment plan, what is included in the treatment, the duration of the treatment and the total cost for the treatment, including the cost of the initial payment or cost of the monthly payments.
    • Denti-Cal denial letter or Handicapping Labio-Lingual Deviation (HLD) Index  scoring sheet (if available) – provided by the orthodontia treatment provider
    • W-9 form – completed by the orthodontia treatment provider
    • Consent for treatment by one of the following:
      • An individual who holds the rights to consent for medical/dental treatment (usually a parent/legal guardian or designated educational/developmental rights holder)
      • An NMD
      • A court order or attorney order signed by a Juvenile Court Hearing Officer specifying Court is authorizing orthodontia treatment for (youth/NMD’s name). Please note, this is required if parental rights have been terminated and there is no one with medical decision-making rights.
      • In instances of co-educational/developmental rights holders, the person who is eligible and available to sign.
    • Service Agreement Letter, signed by:
      • The CSW
      • The orthodontia treatment provider
      • The caregiver
  3. Maintain contact with the Orthodontia Program staff
    • Document communications, activities, and updates regarding identifying a funding source in the CWS/CMS Delivered Service Log and Health and Education Passport (HEP).
      • The Orthodontia Program staff review each referred child/youth/NMD’s case situation through the completion of a screening process.
      • The Orthodontia Program staff maintain a separate (non-CWS/CMS) log noting the activities completed to identify and access an orthodontia funding source for the child’s orthodontia treatment.
      • Once a funding source has been identified and a plan is in place for the initiation of the orthodontia treatment regardless of the funding source, the Orthodontia Program staff hands off the ongoing monitoring of the youth’s orthodontia treatment to the child/youth/NMD’s assigned CSW.
      • In instances of adoptive placement, when the funding request is approved, an assigned worker from the DCFS Special Payments Unit will send a Letter of Intent via email to the provider and to the assigned CSW with billing instructions. Finalization of adoption can then proceed once the Letter of Intent is received. Payment will continue until the end of the orthodontia treatment.
  4. File the items located in item #2 and any other orthodontia-related provider documentation in the case file (purple folder).
  5. Provide ongoing monitoring of the child/youth/NMD’s orthodontia treatment through contacts with the caregiver and child during monthly home visits.
    • If concerns arise regarding caregiver or child/youth/NMD’s compliance with the treatment, or with the orthodontia provider’s delivery of services, consult with your SCSW, ARA, the out-stationed PHN, and/or County Counsel, as needed.
  6. At the completion of the treatment, confirm with the caregiver, child/youth/NMD and orthodontia treatment provider that the treatment was completed.
    1. Consult with the PHN, as needed
    2. Document the information in the child’s Health and Education Passport (HEP).
    3. File any written documentation received from the orthodontia treatment provider in the HEP Binder.
APPROVALS
None
HELPFUL LINKS

Attachments

Sample Denti-Cal Denial Letter
Sample HDL
Sample W-9, Request for Taxpayer Identification Number and Certification

Forms

Consent Form Template
NMD Consent Form Template
W-9, Request for Taxpayer Identification Number and Certification

LA Kids

001-40, Orthodontia Referral Form and Instructions
DCFS 5540, Special Payment Authorization Request
Supportive Therapeutic Options Program (STOP)
REFERENCED POLICY GUIDES

0080-505.20, Health and Education Passport (HEP)
0400-503.10, Contact Requirements and Exceptions
0600-500.30, Public Health Nurses (PHNs): Roles and Responsibilities
0900-521.10, Service-Funded Activities (SFA)
1200-500.90, Model Case Format

STATUTES AND OTHER MANDATES

WIC Section 16501(a)(1) – Defines Service Funded Activities (SFA) and their funding source.

WIC Section 16501(a)(2) – States that Service Funded Activities (SFA) must be determined by each county, based on individual child and family needs, as reflected in the service plan.