Legislation defining California’s Essential Health Benefits, which federal health care reform requires to include pediatric oral health benefits, has been signed by Gov. Jerry Brown.
SB 951 by Sen. Ed Hernandez (D-Los Angeles) and AB 1453 by Assemblyman Bill Monning (D-Santa Cruz), chairs of the Senate and Assembly Health Committees respectively, define the health, vision and pediatric dental benefits that will be offered through California’s Health Benefit Exchange as part of its implementation of the Affordable Care Act (ACA).
CDA, in partnership with the California Society of Pediatric Dentistry, successfully led the effort to design the pediatric dental benefit included in the bills to ensure the dental benchmark mirrors the benefit package offered under the Healthy Families Program (HFP) plan. The bills also include a special reference that ensures access to medically necessary orthodontia.
CDA supported the adoption of the Healthy Families pediatric dental benefit because that program, with its benefit package, has a proven track record of meeting the oral health needs of California children and the professional standards of California dentists. The HFP dental benefits package was the preferred benchmark since it was developed exclusively for children and contains all necessary pediatric oral health services as mandated by the Early Periodic Screening, Diagnosis and Treatment (EPSDT) requirements of Medicaid law, without adding costly elements such as non-medically necessary orthodontic care.
It is important to note that establishment of this benchmark is not meant to replicate the HFP dental plans themselves (contractual provisions, reimbursement, etc.), but rather to identify a specific set of services that must be made available by plans offering dental benefits in the Exchange.
While estimates of the number of children who will access these dental benefits through the Exchange are still very preliminary, some estimate between 1.2 million and 1.5 million additional children will have access to dental benefits in California through this program. CDA will continue to be an active participant in discussions as California moves toward full implementation of the ACA by Jan. 1, 2014. For any additional information, please email Nicette Short at CDA or call 916.554.4970.