MedicaidPrior AuthMedium impact
Orthodontic Handicapping Labio-Lingual Deviation (HLD) Tool Changes per Public Act 103-0593
Illinois Medicaid - HFS·IL · Dentistry·Provider Notice
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Illinois Medicaid expanded the Handicapping Labio-Lingual Deviation (HLD) orthodontic scoring tool to include six new automatic qualifiers for orthodontic treatment coverage, effective January 1, 2025. Dental vendors must now provide HLD scoring details when denying prior authorization requests, and providers can request reconsideration for cases denied after January 1st that would qualify under the new criteria.
Action Required
Immediately: Contact appropriate Medicaid dental vendors to request reconsideration for any orthodontic prior authorization denials after January 1, 2025 that may now qualify under expanded HLD criteria (cleft palate, deep impinging bite with tissue damage, anterior crossbite with gingival recession, severe traumatic deviation, overjet ≥9mm, or impacted teeth). Update prior authorization workflows to reference new automatic qualifiers when submitting orthodontic treatment requests to Illinois Medicaid and MCOs.