Dental coverage: where things stand

By the CDHP team

Earlier this month, Republicans in Congress introduced the American Health Care Act (AHCA). This bill would make sweeping changes to the Affordable Care Act (ACA) by restructuring health insurance subsidies, eligibility rules and a variety of funding mechanisms. It also seeks to fundamentally change how Medicaid is financed. Given that these changes could have a significant impact on oral health for children and families, let’s take a closer look at current coverage policies, how this bill could change those policies and how advocates can have positive discussions with policymakers on this issue.

CDHP provided some analysis during last week’s webinar, which you can view here.  In addition, take a look at our Why Dental Coverage Matters tool-kit, which includes a number of other resources.

Where are we now (especially with oral health)

Medicaid and CHIP covers more than 45 million children and about 1 in 5 Americans overall. To put that in perspective, together, Medicaid and CHIP provide comprehensive medical and dental coverage to one-third of all children.

More importantly, these programs are effective. Studies show that access to prenatal and child health care through Medicaid and CHIP improve not only health (like fewer emergency department visits, lower incidence of obesity and oral health problems in adulthood), but also a variety of indirect outcomes including educational performance and employability.

Studies show that an increase in adult coverage is strongly linked to an increase in children's coverage, especially in states with Medicaid expansion.

Under Medicaid, children’s care is directed by the federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit guidelines, which translate into a comprehensive benefits package for children. States maintain considerable flexibility over many aspects of how these programs are administered. Similarly, CHIP programs are run by states, and despite passing some costs on to families, they also provide for comprehensive benefit packages, including dental coverage. Thanks to these programs, the number of children without dental coverage has dropped by 58% since 1997, when CHIP was established.

While covering dental services for adults is optional for state Medicaid programs, the ACA’s Medicaid expansion saw about 5 million more adults gain access to dental coverage. In addition, the ACA simplified the method for enrolling in health care coverage, including streamlining eligibility determinations for public programs. This step was important because it identified adults who qualified for public insurance, but it also found children who had fallen through the cracks. In fact, studies show that an increase in adult coverage is strongly associated with an increase in children's coverage, especially in states with Medicaid expansion.

The ACA also made children’s oral health an “Essential Health Benefit.” This meant that privately insured children also had increased access to dental coverage. In addition, the ACA made private dental insurance more accessible for adults. In fact, the US saw a rise in adults with dental coverage, including over 1.3 million who purchased stand-alone dental insurance on top of medical insurance.

What could happen under AHCA?

Notably, Medicaid payments to states would change to a per-capita cap system (i.e., a fixed dollar amount per enrollee) which would push significantly higher costs onto states. The cap would not adequately adjust for the inflation of health care costs over time. With fewer federal Medicaid dollars, states would likely make cuts to coverage or the populations served. This could result in access issues for children, lower reimbursement rates for providers and/or the loss of dental benefits for adults.

With fewer federal Medicaid dollars, states would likely make cuts to coverage or the populations served.

In addition, the AHCA removes the individual mandate to purchase insurance, shrinks credits to individuals to purchase insurance and weakens protective pricing mechanisms which allowed individuals to afford insurance. Without adequate tax credits and cost-sharing subsidies, families are likely to see higher out-of-pocket costs and may be less inclined to purchase dental coverage for their children.

In fact, this week, the Congressional Budget Office (CBO) released its official score of AHCA, noting that it would result in tens of millions of Americans losing coverage. Furthermore, the bill is silent on the future of CHIP, which will run out of funding this fall if Congress does not act.

The U.S. has made important strides over the last few years improving access to and affordability of health care, especially oral health care, for millions of Americans. It is imperative that any new policies build on these accomplishments, rather than leaving millions of working families out in the cold.

What can you do?

CDHP has created a toolkit to help you follow these complex issues and support efforts to engage policymakers. We encourage you to check out our webinar, share our “Fast Facts” handout with your elected representatives, and even take a look at letters we have written to inspire your own correspondence.

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Did you know?

75% }
of American Indian/Alaskan Native children have experienced caries by age 5.
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