As Tara Mancini has observed, more and more of us in the health care world are coming to the stunning realization that the mouth is part of the body. To care for kids’ health properly, we need to give them quality, effective oral health services. The ACA recognizes this: it makes pediatric dental benefits one of the services that must be included in the essential health benefits (EHBs). But since coverage for dental benefits has historically been offered apart from other health coverage (as if the mouth and body were separate), bringing all of these benefits together in the EHBs raises some issues.
To help sort through some of these issues, we here at Georgetown CCF collaborated with experts at the Children’s Dental Health Project to produce a short issue brief. It looks at some of the key changes the ACA makes to children’s dental benefits and the choices states face in defining what those benefits will be for kids covered in the individual and small group insurance markets. And it makes some recommendations for those who want to help their states support effective coverage for kids.
Like the rest of the essential health benefits, the changes to pediatric dental benefits will most directly impact those who get coverage in the individual and small group markets. Kids in Medicaid and CHIP will continue to get dental benefits has they do currently and kids who are covered through parents’ large employer plans also won’t be directly affected (though over time, the EHBs may come to influence large plans, too). The brief notes these coverage paths and discusses some steps for making the most out of the improvements coming to the non-group and small group markets.
The brief is intended just to highlight some of the complexities that surround pediatric dental benefits under the ACA. As states make EHB choices, many more questions are likely to come up. That’s where we’d like to hear from you. The authors—Meg Booth and Colin Reusch at the Children’s Dental Health Project and myself for CCF—are eager to talk through any concerns that come up. Please reach out if we can answer any questions or if you just want to share what’s happening in your state.