Update on access to dental care in ACA implementation

By Nicette Short, CDA Manager, Legislative Affairs

The U.S. Department of Health and Human Services (HHS) recently issued final rules regarding the implementation of the Affordable Care Act (ACA) that included much needed clarification on federal policy related to access to dental care inside and outside of the Health Benefit Exchanges — the health and dental insurance marketplaces created by the ACA.

Through its policy decisions included in the new rules, HHS clearly indicates the importance of ensuring standalone dental benefits remain one of the options being offered to consumers — both inside and outside of the Exchanges — after full ACA implementation in January 2014. These rules clear up some concerns and identify new efforts that the California Health Benefit Exchange (Exchange) and the California Legislature must now undertake to ensure consumers have the best access to both the pediatric dental Essential Health Benefit and the optional adult supplemental benefit.

While these recently released federal rules have clarified some key issues, including that states can offer medical plans without the pediatric dental benefit both inside and outside of the Exchange so that families can pair their medical benefits with standalone dental plans, there remains a need to correct state law in order to accommodate these new federal guidelines.

In a key development surrounding the implementation of the ACA, after extensive advocacy from CDA with Assemblymember Richard Pan (D-Sacramento), chair of the Assembly Health Committee, Speaker John Perez (D-Los Angeles), and many other key legislators and staff, Assemblymember Pan has committed that AB 18 (Pan) will be amended to address CDA’s ongoing concerns about maximizing patient choice of dentists and dental plans both within and outside of the Health Benefit Exchange marketplace.

CDA’s hope is to clarify several key policy issues governing dental benefits, including whether parents have the ability to choose to purchase their child’s dental coverage through their medical plan or through a separate dental plan. Many details remain to be worked out regarding the bill’s specific language in the weeks ahead, but the joint commitment of the Assembly Speaker and the Health Committee chair to address CDA’s concerns is a significant breakthrough.  

CDA Advocacy and Engagement

CDA’s advocacy on these issues remains strong. CDA Executive Director Peter DuBois recently held a productive meeting with Peter Lee, the executive director of the Health Benefit Exchange Board, to ensure the Exchange staff at the highest level is informed of the critical issues regarding access to dental care as California moves toward implementation of health care reform. Issues discussed included the unique nature of dental benefits as compared to health insurance, and CDA’s specific recommendations for policy changes that the Exchange Board can make to ensure the Exchange is a fair and open marketplace for consumers to make well-informed purchases of dental benefits and to ensure families have the ability to retain their dentist when they purchase coverage so that continuity of care can be maintained. Lee expressed interest in continuing to hear from CDA on the many dental issues still pending before the Exchange Board.

As details on the ACA’s implementation continue to emerge and develop, CDA is maintaining its strong advocacy on these critical and complex issues. CDA recently held additional meetings with key members of the California Health Benefit Exchange Board, and is in frequent consultation with Exchange staff and Legislative staff. These efforts include providing testimony at Exchange Board meetings, submitting extensive written comments regarding the solicitation for bids from plans to provide the supplemental adult benefits that will be offered in the Exchange as well as comments on the Emergency Regulations governing a range of issues affecting dental benefits in the Exchange.

CDA will continue its active engagement on these key issues on behalf of its member dentists and the patients they serve.

For more information, please contact Nicette Short at CDA at nicette.short@cda.org or 916.554.4970.