Illinois Medicaid orthodontic scoring tool updated

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The orthodontic scoring tool within the Illinois Medicaid program has updated its rules and scoring criteria.

The update is in part due to the Illinois State Dental Society’s work during the 2024 legislative session to secure $12 million in funding to modernize the tool and improve access to orthodontic care, according to a March 27 news release from the ISDS.

The updates apply retroactively to Jan. 1, 2025.

Here is the updated scoring tool.

Automatic qualifiers now include the following conditions:

  • Cleft palate or other craniofacial anomalies
  • Deep impinging bite with signs of tissue damage, not just touching palate
  • Anterior crossbite with gingival recession
  • Severe traumatic deviation
  • Overjet of 9mm or greater 
  • Impacted teeth where eruption is impeded but extraction is not indicated
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