Impact of Medicaid Expansion on State-Level Medicaid Reimbursement for Orthodontia in Patients With Cleft Lip and Palate: A Cost Analysis.

This article examines state-level Medicaid reimbursement rates for Phase I (limited orthodontic treatment of transitional dentition) and Phase II (comprehensive orthodontic treatment of adolescent dentition) orthodontia relevant to patients with cleft lip and palate (CL/P) following Medicaid expansion under the Affordable Care Act. Analysis of 2024 publicly available Medicaid fee schedules from 50 states and DC found that coverage for Phase I orthodontia remains limited across both expansion and non-expansion states, while Phase II coverage is more widespread, with significantly higher reimbursement rates in expansion states and Southern regions. Despite Medicaid expansion increasing eligibility, reimbursement rates—particularly for Phase I care—are generally low, which may discourage provider participation and contribute to delayed or forgone orthodontic treatment for low-income children with CL/P. The study highlights persistent disparities in access to early orthodontic care essential for optimal cleft outcomes and calls for coordinated policy reform, advocacy, and partnerships between academic centers and community providers to improve equitable access.