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Day 0: Phone call
Free evaluation booked within a few days at the closest Stellar office. No paperwork from you.
The Medicaid Braces Process
The Delaware Medicaid braces process, start to finish.
From the first phone call to the day the braces come off, here is exactly what happens with a Delaware Medicaid orthodontic case at Stellar. We handle the paperwork. You bring your child to the appointments. This page explains every step in plain English, with realistic timelines for each phase.
Timeline at a glance
How long does the whole process take?
The pre-treatment phases (call → evaluation → pre-auth approval) typically run 3 to 6 weeks total. Active treatment averages 18 to 24 months for pediatric cases. Retention is lifelong.
Week 1: Free evaluation
60-minute visit. Full exam, diagnostic records, HLD Index scoring. You learn whether your child qualifies before leaving.
Weeks 1–5: Pre-authorization
Stellar submits the records package electronically. Plan reviews and issues a decision in 2 to 4 weeks.
Week 5–6: Braces placement
60-90 minute appointment. Brackets bonded, first wire placed. Active treatment begins.
Months 1–24: Adjustments
Every 6 to 8 weeks. Same orthodontist each visit. About 30 minutes per appointment.
Removal & retention
Braces come off in one appointment. Custom retainers protect the result for the long haul.
Step 1 - The free evaluation
What happens at the first visit.
About 60 minutes. No cost. No obligation. The free evaluation is where we determine whether your child meets Delaware Medicaid's medical-necessity criteria for orthodontic treatment.
- Intake: we confirm the Medicaid plan, member ID, and date of birth from the card you bring
- Clinical exam: the Stellar orthodontist evaluates the bite, alignment, soft tissues, and oral structures
- Diagnostic records: intraoral and facial photos, panoramic x-ray, cephalometric x-ray, 3D iTero scan
- HLD scoring: the orthodontist completes the Delaware HLD Index form using the exam findings
- The verdict: you learn whether your child qualifies before you leave the office
If you want the full eligibility breakdown before the visit, see our eligibility guide with the HLD Index walkthrough.
What to bring to the evaluation
- Your child's Medicaid member ID card
- Your child's date of birth
- Photo ID for the parent or guardian
- Any prior dental or orthodontic records (helpful but not required)
- A list of your questions - we'll answer all of them
Don't bring: payment. The evaluation is free regardless of whether your child qualifies for Medicaid braces coverage.
Step 2 - The records package
What Stellar submits to your managed-care plan.
A Medicaid pre-authorization package is essentially a complete clinical case file. Plans require enough documentation to confirm medical necessity independently. Stellar assembles every component and submits the package electronically - you don't touch any of it.
Diagnostic photos
Standardized intraoral and facial photos: front smile, front retracted, right and left buccal, upper and lower occlusal, full face. These let the plan reviewer see the case the way the orthodontist did.
Panoramic x-ray
A single panoramic image showing all teeth, roots, supporting bone, and the jaw joints. Reveals impacted teeth, missing teeth, root angulations, and any pathology.
Cephalometric x-ray
A side-view skull image used for orthodontic measurements. Critical for cases involving jaw growth, severe overjet, or skeletal issues.
Digital iTero scan
A 3D model of the teeth and bite that replaces traditional plaster study models. Faster, cleaner, and reviewable by the plan in standard digital formats.
HLD Index form
The completed Handicapping Labio-Lingual Deviations form, scored by the Stellar orthodontist. The form drives the medical-necessity determination.
Clinical narrative
A brief written summary from the orthodontist explaining the diagnosis, the medical-necessity rationale, and the planned treatment approach.
Step 3 - Plan submission and review
How submission works at each managed-care plan.
All three Delaware managed-care plans accept electronic pre-authorization submissions. Each has its own provider portal. Stellar's team is set up on all three and submits directly - nothing is mailed, faxed, or hand-delivered.
- Highmark Health Options: records submitted through the Highmark provider portal. Reviewed by their dental consultant team. More on Highmark
- AmeriHealth Caritas Delaware: records submitted through AmeriHealth's provider portal. Reviewed by their dental consultant team. More on AmeriHealth
- Delaware First Health: records submitted through the Delaware First / Centene portal. Reviewed by their dental consultant team. More on Delaware First Health
- CHIP (Delaware Healthy Children Program): same MCO infrastructure as the corresponding DSHP plan
Realistic decision timelines
Each plan's processing time varies slightly, but the realistic range across all three is:
- Fastest: 7 to 10 business days for clear-cut cases with strong HLD scores or auto-qualifying conditions
- Typical: 2 to 3 weeks for most cases
- Longer: 3 to 4 weeks for borderline cases that require additional review or supplementary documentation
We notify you the same day we receive the determination, either way.
Step 4 - What happens after approval
From approval to braces day to retention.
Notification & scheduling
The plan notifies Stellar electronically. We call you the same day and schedule the braces placement appointment, typically within 1 to 2 weeks of approval.
Braces placement
A 60 to 90 minute appointment. Brackets are bonded to the front of each tooth. The first archwire is placed. No injections, no drilling, no pain. Most kids walk out smiling.
Adjustment visits
Every 6 to 8 weeks for the rest of active treatment. About 30 minutes per visit. Wires changed, elastics swapped (kids pick colors), progress documented. Same orthodontist every appointment.
Active treatment
Average 18 to 24 months for pediatric cases. Some shorter, some longer. The pre-auth approval covers the full case length under Delaware Medicaid policy.
Removal day
Brackets come off in a single appointment. Kids are usually stunned by the reveal. The covered services include the removal visit and a final cleaning.
Retention
Custom retainers protect the new smile long-term. Wear schedule starts full-time and tapers over the first year. Initial retainers are covered by Medicaid.
If pre-auth is denied
You still have options.
Denials happen, usually for one of three reasons: the HLD score was below the qualifying threshold, the plan reviewer disagreed with the medical-necessity rationale, or the records were incomplete. Stellar reviews every denial and walks you through the next steps.
- Written appeal: a formal appeal letter to the plan with additional clinical documentation. Many borderline cases overturn on appeal when more context is provided.
- Peer-to-peer review: a direct phone call between the Stellar orthodontist and the plan's dental consultant. Sometimes the case can be resolved with a clinical conversation.
- Delaware Medicaid fair hearing: a formal hearing through Delaware DMAP for cases that remain unresolved after the appeal and peer-to-peer paths.
- Private-pay path: if appeals don't succeed and you'd still like to proceed with treatment, we walk you through monthly financing options.
What Stellar does NOT do
- Start active treatment before pre-authorization approval (Medicaid won't retroactively cover services rendered before authorization).
- Charge for the free evaluation, regardless of the outcome.
- Pressure you to proceed if pre-auth is denied. Private pay is your choice, never a sales push.
- Abandon a patient mid-treatment if coverage is lost. We work with you on a path forward.
Process FAQ
Honest answers to process and pre-auth questions.
How long does pre-authorization take?
Typically 2 to 4 weeks once Stellar submits the complete records package. Highmark Health Options, AmeriHealth Caritas Delaware, and Delaware First Health each have their own processing timelines, but 2 to 4 weeks is the realistic range.
What's in the records package?
Diagnostic photos, a panoramic x-ray, a cephalometric x-ray, a 3D iTero digital scan (replacing study models), the completed HLD Index form scored by the orthodontist, and a clinical narrative. Stellar assembles and submits all of it electronically.
Do I have to submit anything myself?
No. Stellar's team handles the entire pre-authorization submission. The only things we need from you are your child's Medicaid member ID card and date of birth.
What if pre-authorization is denied?
Stellar reviews the denial reason and walks you through the appeal options: written appeal, peer-to-peer review between the Stellar orthodontist and the plan's dental consultant, or a Delaware Medicaid fair hearing through DMAP. Private-pay options are also discussed if you'd like to proceed regardless.
Can treatment start before approval?
No. Beginning treatment before pre-authorization is approved means the case is private-pay by default, and Medicaid will not retroactively cover services rendered before authorization. The free evaluation is always free regardless.
How often will my child come in once treatment starts?
Every 6 to 8 weeks for adjustment visits. About 30 minutes each. Same orthodontist every visit. The cadence stays the same throughout active treatment, which averages 18 to 24 months for pediatric cases.
What happens if coverage lapses mid-treatment?
Call us immediately. Stellar walks you through the options - recertifying coverage, transferring to a private-pay plan with monthly financing, or pausing the adjustment cadence while you resolve coverage. We will not abandon a patient in active treatment.
Do I owe anything when braces come off?
No member cost-share for the covered services, including the removal appointment and the initial set of retainers. Replacement retainers (lost or broken after the initial set) are typically a private-pay cost.