Health Law Requires Pediatric Dental Coverage

Posted on: January 21st, 2013 by SamTabes No Comments

Health care reform is requiring that individual and small group health insurance plans sold on the state-based health insurance exchanges and on the private market offer dental coverage to children.  This is in response to the fact that tooth decay currently ranks as the number 1 chronic disease among children.  While this effort is commendable, it may not be realistic.  Many children’s health advocates are concerned there will not be enough dentists who are willing or able to treat the vast amount of children who will have coverage once health law is fully implemented.

Pediatric dental coverage is already available under Medicaid, but many children are not using these services according to Michelle Andrew’s article on  Families are unaware of the benefits that are available for their children through dental coverage and have not enrolled in the various plans.  Health care reform is working to make coverage more available as it expands coverage to adults with incomes up to 133% of the federal poverty level.  There is concern that as the amount of coverage rises, the availability of dentists to treat these children will decrease.

Colin Reusch, a senior policy analyst at the Children’s Dental Health Project, points out that many dentists are not particularly comfortable seeing young children since many are uncooperative in the dental chair.  Reusch co-authored a recent study on the law’s pediatric dental coverage and found that it will face many challenges.  Families of children who are using Medicaid run into language barriers and struggle to find transportation options.  A lot of times they cannot find a dentist who accepts Medicaid nearby.  All of these barriers leave experts wondering if more children will actually be treated under the health law requirement.

The Government Accountability Office completed a report in 2010 that found less than half of the dentists in 25 out of 39 states took any Medicaid patients in the previous year.  This is a shocking statistic that begs the question why?  Part of the reason is the dentists decision, but also the fact that Medicaid families may be unaware they even have dental coverage.  Health care reform could increase awareness and may encourage more dentists to see more children and accept Medicaid more often.

Shelly Gehshan, director of the Pew Children’s Dental Campaign says many rural areas simply do not have enough dentists to fulfill the needs of covered children.  Gehshan says there is a huge and well-documented access problem in the United States, with 45-50 million people living in areas where there is a shortage of dentists, especially ones that accept Medicaid and treat children.  On the other hand, President of the American Dental Association, Robert Faiella, says there isn’t really a shortage of dentist services.  He believes roughly 73% of dentists are able to accept more patients and are not completely full.

Dentists are trying to work with more community health centers and local dentists to provide to assist with distribution problems.  Dental insurance is an important part of the heath care industry and it’s good news that it’s being considered in health care reform, even if it only addresses primarily children at this point.  Children can be at high risk of serious tooth decay and early intervention is key.  If health care reform can help more children see a dentist and prevent serious dental health issues, then it’s in the best interest of all families.

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