By Mary Otto

While the Affordable Care Act (ACA) only imperfectly addressed American’s wide lack of dental coverage, oral health advocates and analysts have applauded progress in getting oral health benefits to more Americans under the health care reform law.

The ACA includes pediatric dental benefits among the essential health care benefits required for sale on federal and state insurance exchanges. Adult dental benefits are not required by the law but have been made available on some exchanges.

In terms of public coverage, children are entitled to dental benefits under Medicaid; benefits for poor adults are regarded as an optional part of program and vary widely from state to state. Still, under Medicaid expansion under the ACA, millions of children and adults have acquired dental coverage. With the possible revamping or dismantling of the law, concerns are being raised that dental benefits could be lost.

Joanne Fontana, of Milliman, an independent actuarial firm, credits the ACA with bringing “sweeping changes in the dental insurance industry.” As conservative efforts to repeal and replace the law have continued to unfold, Fontana takes a detailed look at the possible implications for dental benefits in a May 2017 white paper, “Here We Go Again: Potential Impact of Healthcare Reform on Dental Insurance.”

Dental benefits have been typically sold separately from other health care benefits and the ACA, like other federal programs that came before it, did not manage to address this disjoint.

To learn more about how dental coverage is distributed, check out this fact sheet from the NADP.

And for some additional useful background on how private dental benefits have been handled on insurance marketplaces, you may want to read this brief from the National Academy for State Health Policy, “Dental Benefits and Health Insurance Marketplaces: An Update.”

The American Dental Association (ADA) estimated that about 8.7 million children would gain some form of dental benefits by 2018 as a result of the ACA. For more about the expansion of dental benefits to children see this research by the ADA’s Health Policy Institute (HPI).

For a broad look at progress getting coverage to children under Medicaid and the importance of the Early and Periodic Screening Diagnosis and Treatment Benefit in providing services including dental care, see this brief from the Henry J. Kaiser Family Foundation.

While poor adults are not entitled to dental benefits under Medicaid and funding for dental services is vulnerable to cuts, many states offer at least limited coverage. By 2015 under Obamacare, an estimated 5.4 million adults gained dental benefits through Medicaid expansion in the states, the ADA determined.

For more about the impact of adult dental benefits under Medicaid expansion, there is this useful study “Medicaid Adult Dental Benefits Increase Use Of Dental Care, But Impact Of Expansion On Dental Services Use Was Mixed,” published in April in Health Affairs.

Lastly, this brief “Access to Dental Care in Medicaid: Spotlight on Nonelderly Adults” from the Henry J. Kaiser Family Foundation also looks at recent trends in adult dental coverage under Medicaid.

Mary Otto 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.” If you have questions or suggestions for future resources on the topic, please send them to mary@healthjournalism.org.