State’s ‘misstep’ means Calif. kids need separate dental plans

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Pediatric dental coverage was designated as one of 10 essential benefits under Affordable Care Act. But most dental insurance is sold separately from other kinds of health insurance.

As Oct. 1 approaches and states work to set up health insurance exchanges, it will be interesting to see how they handle the complicated task of integrating dental coverage into the benefit packages offered for sale. States can offer the benefits in three ways: embedded into qualified health plans for sale on the exchanges, as stand-alone plans that are bundled with medical plans, or as separate stand-alone plans.

California children’s advocates, who stress the benefits should be affordable and easily accessible, hoped that pediatric dental benefits would be embedded into the health plans going on sale when the state’s insurance marketplace, Covered California, opens for business.

But they got some disappointing news.

Amid apologies, Covered California officials announced customers who want to purchase pediatric dental benefits will need to buy separate stand-alone dental plans, at least for awhile.

The arrangement has advocates worrying that kids could go without dental care. It also has exchange officials promising to go back to the drawing board on pediatric dental coverage, as Chad Terhune reported in an Aug. 8 story for the Los Angeles Times.

Amid criticism from the state insurance commissioner and some children’s advocates, California’s health insurance exchange is moving ahead with a controversial approach to children’s dental coverage for next year while vowing to pursue changes for 2015.

At issue has been whether pediatric dental care should be part of the basic health insurance package sold through the exchange or be sold separately. The exchange, called Covered California, will be offering it on a stand-alone basis to parents next year.

Advocates have argued that embedded dental benefits would expand children’s access to dental care and lower the costs of the benefits by distributing the burden of paying for them across a broader group of people.

(A final rule, issued earlier this year by the U.S. Department of Health and Human Services heightened concerns that cost sharing-limits could raise additional affordability barriers for families buying stand-alone dental benefits. A report on DrBicuspid.com did a good job of delving into that complex twist to the story.)

Meanwhile, detractors of embedded dental benefits in California have contended that people who do not need or want pediatric dental benefits should not be required to buy them. Some state officials say that embedding dental benefits into medical plans would make it harder for consumers to comparison shop for coverage.

At an Aug. 8 meeting, Covered California officials told children’s advocates it was too late to re-bid contracts for embedded dental benefits for this year.

“Meantime, state officials apologized for missteps in how they handled the rollout of children’s dental benefits,” Terhune wrote.

In a staff report, Covered California acknowledged that in April it “incorrectly instructed health plans not to bid embedded plan offerings…. Covered California should have welcomed bids of embedded, bundled or stand-alone offerings.”

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