Wellness Visits FAQS

It is important for your child to be seen by a dentist after your child’s first tooth appears or no later than 12 months of age.  

Children with untreated cavities can have pain and infections that may lead to problems with eating, speaking, playing and learning. 

Dental exams are covered two times per calendar year. Teeth cleaning, x-rays, sealants and fillings may also be covered.

Yes. Fluoride varnish is covered:

Three times per calendar year by a dentist and  

Two times per calendar year by a nondental clinic (pediatrician, local public health unit, etc.) for children ages 6 months through 20 years old.

Ask your provider during a wellness visit if fluoride varnish is an option.

ND Medicaid will help with transportation for medical appointments. Contact the Customer Support Center to schedule a ride to an appointment. Please call as soon as you schedule your medical appointment to allow time for drivers to be available. 

Phone: (866)-614-6005 or (701) 328-1000; 711 (TTY) 
Fax: (701) 328-1006  
Mail: Customer Support Center 
         P.O. Box 5562 
         Bismarck ND 58506 
Email: applyforhelp@nd.gov 

You can check the Insure Kids Now website for participating oral health providers. 

To start, a child must have two orthodontic screenings:

• one from a local public health unit or dentist and
• one from an orthodontist

If the child meets the point level under these screenings, the orthodontic screening will be sent to ND Medicaid in for review.  

This review process takes around 4-6 weeks. You will then be contacted regarding the approval status. 

Here are a few signs that your child may need orthodontic care.  

• Teeth that meet in an abnormal way or don’t meet at all  
• Hard time chewing or biting
• Breathing problems due to teeth/jaw placement
• Sleeping problems due to teeth/jaw placement
• Late or early loss of baby teeth
• Crowded teeth  
• One side of their face looks different from the other or certain features don’t line up evenly

Learn more at the American Association of Orthodontists website. 

ND Medicaid may pay for braces for children ages 7 through 20 when medically necessary.

Yes.  When you call for your appointment, confirm that your orthodontist of choice accepts ND Medicaid. 

You can check the Insure Kids Now website for participating oral health providers.

No. Only bracketed orthodontia is an option. Prior approval may be given for different treatment when medically necessary, but not for cosmetic reasons. 

ND Medicaid pays the full cost of orthodontic treatment up front, even if you no longer qualify for ND Medicaid.  

It is important to continue your orthodontic treatment until it is done.

A transfer may be an option on a case-by-case basis. Please work with your orthodontists in this case.  

No. Orthodontic care for members can’t be reimbursed by Medicaid for care before they qualified.  

Members age 0 through 20 are limited to one exam and one pair of glasses every 365 days. If new glasses are required for a big change in correction, the glasses need to be prior approved. 

Certain lenses and frames are covered. Ask your provider to see options. 

Members (age 20 and under) who lose or break their first pair of eyeglasses, and the damage is not covered by the warranty, ND Medicaid will replace one pair of eyeglasses within the 365-day replacement timeframe. All replacement requests must be approved by ND Medicaid.

Adults (age 21 and older) who lose or break their eyeglasses within the two-year replacement timeframe, ND Medicaid will not cover another pair. 

Contact lenses and dispensing fees require prior approval and are covered only when medically necessary and not for cosmetic reasons.  

There is no minimum age limit. If you have vision concerns for your child, please schedule a vision exam for them with a participating ND Medicaid provider.  

No, glasses for members who become eligible for Medicaid going back are not covered. However, eye exams are covered for members who become eligible going back. 

For example, a member had an eye exam and ordered glasses on July 15th, then on September 1st, the member became eligible for Medicaid going back to July 1st. ND Medicaid would cover the eye exam, but not the glasses. 

A wellness visit covers many preventive services to keep your child healthy including:

• Dental exams, cleanings, braces, fluoride varnish
• Vaccines  
• Prescriptions
• Behavioral health screenings
• Vision checks and glasses
• Hearing checks and hearing aids
• Autism Applied Behavioral Analysis therapy
• Physical, occupational and speech therapies
• Growth and development checks
• And other health services 

Children should get these checkups at regular times, even when they are feeling well.

Babies grow fast and need a lot of checkups. These should be done at:

• 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months

Toddlers need checkups at:

• 15 months
• 18 months
• 24 months
• 30 months

After 30 months, children need a checkup at age 3 and then yearly up to age 21. Additional checkups are also covered based upon a child's needs. 

Getting care early helps prevent small problems from turning into bigger ones. Wellness visits make sure children get the right care at the right time in the right care setting.  

They help:

• Catch health issues early
• Prevent illness
• Make sure a child gets vaccines and other needed care

These visits allow parents or caregivers a chance to ask questions and discuss concerns they may have. 

Wellness visits are preventive care. All children and teens need regular visits, even when they feel healthy.  

It is the member's choice where to establish care. You may choose any provider that accepts ND Medicaid. You can also see a local public health unit. 

Please visit the Member Engagement webpage to find out more about member benefits. 

No. Wellness visits are preventive care. They are more complete and look at your child’s overall health and well-being. Sports physicals review your child’s current health to make sure they are sports ready.

A sports physical can be done at the same time as a wellness visit.  

If you schedule an appointment with your provider for a wellness visit, make sure to let them know you also need a sports physical. Be sure to bring your sports physical form with you.

To find information including the sports physical form, visit the North Dakota High School Activities Association website. 

Yes, your provider will check your vaccine record, and they can be given if needed. Learn more about immunization schedules on the HHS Immunizations webpage.

Yes. ND Medicaid will help with transportation for medical appointments. Please call as soon as you schedule your medical appointment to allow time for drivers to be available. Contact the Customer Support Center. 

Phone: (866)-614-6005 or (701) 328-1000; 711 (TTY) 
Fax: (701) 328-1006  
Mail: Customer Support Center 
         P.O. Box 5562 
         Bismarck ND 58506 
Email: applyforhelp@nd.gov

The ND DOT Transit Provider Map shows transportation options by area.

For more information on autism services, please visit the Autism Services webpage.