High Court Ruling Opens Dental Benefits to 8 Million Kids

Laird Harrison

June 29, 2012

June 29, 2012 — In the wake of the US Supreme Court's decision on June 28 to uphold the healthcare reform law, advocacy groups are jockeying to influence the way dental coverage will be offered to an estimated 7.8 million newly eligible children.

State and federal regulators, some of whom were waiting to see how the high court would rule, must now formulate rules on health insurance policies, including dental benefits.

The law requires that everyone obtain health insurance, starting in 2014, or pay a punitive tax. Dental benefits for children must be included in that coverage; in addition, the law will prohibit annual or lifetime caps on these benefits.

The law also includes provisions for training more dental professionals, for public information about oral health, and for demonstration projects aimed at early childhood caries, along with a smattering of other provisions that will marginally affect dentistry.

However, analysts agree that the biggest effect on oral care will take place through expanding dental benefits to more children. As the insurance mandate begins to take effect over the next 2 years, dentists may get more and more calls from caregivers who want to set up pediatric appointments.

"I hope dentists see it as a real opportunity," Meg Booth, policy director for the Children's Dental Health Project (CDHP), told Medscape Medical News.

What Kind of Insurance?

Just what kind of insurance these new patients will bring to dentists' offices remains to be determined.

The law expands Medicaid, but not very many children's dental benefits will be affected by this provision because so many indigent children are already covered by a complementary program, the Children's Dental Insurance Program, Booth explained.

It is children who do not qualify for Medicaid or the Children's Dental Insurance Program, who are not covered by employers, and who have guardians who cannot afford to buy dental insurance for them that the law will most affect, at least in the short term.

The CDHP, which fought to include dental benefits in the law, estimates that 7.8 million children in this category will become eligible for these benefits.

However, no one knows how many will sign up, and Delta Dental Plans Association spokesperson Chris Pyle told Medscape Medical News that he worries some caregivers will drop their own dental coverage to afford their children's coverage.

Caregivers will be able to buy health insurance for their children through new exchanges that the law mandates in every state. Although they will still be able to buy insurance outside the exchanges, they can only qualify for discounts or tax credits based on their incomes if they buy through the exchanges.

The key question now is what kind of dental benefits providers will sell on the exchanges. The law permits stand-alone dental plans as well as dental plans that are embedded within medical insurance plans.

Companies such as Delta Dental that sell stand-alone plans now are lobbying for regulations that would allow them to offer plans on the exchanges that are similar to the ones they offer now.

"We are capable and willing and interested in offering our dental benefits through the exchanges," said Pyle.

Federal and state regulators have not yet said what criteria dental plans have to meet to be in the exchanges, however. "You could see different benchmarks in each state," said Pyle.

Lobbying for Benchmarks

Dental policy wonks are also wrangling over the form that the exchanges should take. Federal regulators have given indications that they should resemble online retailers like Amazon or price-comparison Web sites like Priceline and Travelocity, but a prototype Web site designed by 11 states and the federal government did not show a way for shoppers to buy stand-alone dental plans, Pyle said.

Delta would like to make sure caregivers can not only choose from a range of dental plans, including stand-alone plans, but also see which dentists are included in which networks. Families who already have a relationship with a dental office could see which plans include that office.

The CDHP also has ideas about what plans should be offered through the exchanges, Booth said.

The organization would like insurance plans to cover different levels of service depending on a child's risk for dental disease. For example, if a dentist determines that a child is likely to suffer from more caries, then a plan would pay for more than 2 cleanings per year. A child at low risk might get coverage for fewer than 2 cleanings a year.

By allocating resources where they are needed most, dental insurers will save money, Booth said. That way, they can afford to eliminate annual and lifetime caps without increasing their premiums.

CDHP and others are also working on other aspects of the bill. Most notably, they want funding for loan repayment for dental professionals' educations. The law calls for such programs, but Congress has not yet appropriated money for them.

The current US Senate appropriations bill includes "no less than" $150,000 for a public oral health education campaign and $2 million for early childhood caries demonstration projects, both of which are envisioned in the new law. However, the House of Representatives has not followed suit.

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