SIOUX FALLS, S.D. (KELO) — This year South Dakota had nearly 600 teens in foster care — 30% had already been in the foster care system for 3 years or longer.

But 28% just entered state custody in 2022 — a traumatic experience for the teens, but there are also some aspects of care that come as a shock to foster parents.

In order for a teen to enter into foster care, the state department of social services must determine their home is unsafe.

In many cases, that means these kids have experienced, abuse, neglect, exposure to substance abuse or other forms of trauma — but the act of entering into the foster system is traumatic in itself.

“It’s truly one of the most traumatic experiences that they will go through. Even just leaving a traumatic situation and going into a whole new system is a different kind of adjustment they have to make,” former foster teen Kasey Olivier said.

To add to the stress, there are often a lot of appointments.

From physicals to mental health care, foster parents often spend the first few weeks and months of a new placement catching up. And for teens, there’s usually another medical professional to add to that list.

“For the most part we like to start kids in braces when all their permanent teeth are in, so on average between 12 and 13 years old,” Sioux Falls orthodontist Rachel Soyland said. “The majority of people we see do have some sort of functional issue with their bite that could be improved with orthodontics.”

But while braces may be a right of passage for many teens, it’s a much more difficult appointment to make for kids entering state custody.

“Because if you’re in foster care, you’re on Medicaid. And Medicaid doesn’t cover braces or anything that it deems unnecessary that seems really wild to me,” Francis Abbot, foster parent, said. “It’s such a huge need and the fact that it’s not included right now kind of blows my mind, I didn’t expect that at all.”

So how do kids in foster care gain access to orthodontic care and how many might be aging out of the system without it?

In tonight’s KELOLAND Investigates — a look at some of the other gaps in care for all kids on Medicaid, coming up tonight on KELOLAND News.