SIOUX FALLS, S.D. (KELO) — This November, South Dakota voters will have a chance to decide whether Medicaid should be expanded to cover more people.

At the end of August, there were 147,630 the people on Medicaid, including nearly 93,000 children.

Medicaid provides access to health care many families wouldn’t otherwise have, but those who already qualify for the current program still face its limitations.

“There’s a lot of things on Medicaid that aren’t covered,” State representative Kevin Jensen said.

For young patients that often includes contacts and braces.

“Most teens can benefit from orthodontics to improve the function of their bite. But unless they have something considered handicapping like cleft pallet, an impacted tooth, severe crowding, unfortunately they will not be seen as having that handicapping malocclusion and will not be covered for orthodontic treatment,” Sioux Falls Orthodontist Rachel Soyland, owner of 605 Orthodontics + Smile Design, said.

The few extreme cases that may be covered by Medicaid may struggle to find an orthodontist to do the work. KELOLAND Investigates called six Sioux Falls orthodontists; none of them are accepting new Medicaid patients right now.

“There aren’t enough Medicaid providers. Part of that is that the reimbursement rates are so low, it hardly covers the cost of the service,” Soyland said.

“What we cover is what’s federally mandated. Federally, orthodontics are not mandated,” Jensen said.

Jensen was the chair of the Health and Human Services committee; he says state lawmakers often have to make tough calls on what services state Medicaid will cover.

“All teenagers want to look nice. They all want to have the perfect smile. Well, you know what, when I was a kid I did too, but my parents couldn’t afford it. It just comes down to… can we afford every service that everybody wants. We just have to draw the line somewhere,” Jensen said.

But drawing the line at braces often comes as a surprise to parents.

“It really is not common knowledge,” Jensen said. “It’s more common knowledge that dental is covered to a certain degree, but not orthodontics.”

Especially those parents who are new to caring for a child on Medicaid.

“It is weird to be faced with something that you feel should be a given; that’s just how someone should be taken care of. But then you find they care about their teeth, but only to a point. They care about their well-being, but only to a point. That’s really the dark side of the system, it’s built to take care of kids, but is it really built to help them thrive? I’m not exactly sure,” foster mom Frances Abbott said.

KELOLAND Investigates looks at the challenges foster parents face when trying to help a teen in the system access orthodontic care and what this medical care can mean to a kid who’s been through trauma. The full story at 10.