Dental care, once the ignored stepchild of publicly-funded health insurance programs, has become a fundamental element of many plans submitted by states seeking to take advantage of new federal Title 21 funding for Child Health Insurance Programs.
Dental care,long ignored by state programs, is being offered
April 30, 1998
Dental care, long-ignored by state programs,
is being offered in many state CHIP plans
Dental care, once the ignored stepchild of publicly-funded health insurance programs, has become a fundamental element of many plans submitted by states seeking to take advantage of new federal Title 21 funding for Child Health Insurance Programs. In the nation's most populous state, in fact, those covered under the new California Healthy Families Program, to begin in July, will have broader dental benefits than most people in employer-sponsored insurance plans.
Under the plan approved by the Health Care Financing Administration (HCFA) in late March, non-Medicaid children in families with incomes up to twice the federal poverty level will be eligible for a dental insurance plan equivalent to the one provided to state workers and legislators. The maximum monthly premium will be $27, for coverage that includes all basic dental care.
"That includes preventive visits, biannual checkups, cleanings, fillings, sealants and crown and bridge work," said John Grgurina, chief deputy director of the Managed Risk Medical Insurance Board (MRMIB), the agency in charge of putting the Healthy Families Program together "There's no co-pay for basic services, and the co-pay for certain services, like crowns and bridges, won't be more than $5."
The plan doesn't cover orthodontia, although children in low-income families can get medically-necessary procedures covered under the already existing California Child Services Program.
Like the dental coverage already provided under the state's Medicaid program, the Healthy Families package "is richer than any benefit package you could find as a private individual," said Ann Emery, coordinator of the California Dental Association's Council on Dental Care.
Despite the relatively expansive coverage, there was virtually no debate about including broad dental services in the California program, according to Ms. Emery and Mr. Grgurina. The insurance board-known as "Mr. MIB" for its acronym-doesn't have specific figures on how much the dental service will cost, but it's a small percentage of the overall program.
"There wasn't really any discussion about what we should do versus other states, it was just, what should we do," Mr. Grgurina noted.
California is not alone in including broader dental coverage under the Title 21 plans. Child health insurance programs in Wisconsin, Massachusetts, Vermont, Connecticut and Florida all offer dental benefits similar to California's.
Kurt Snodgrass, spokesman for the Oklahoma Health Care Authority, said his state is doing a Medicaid expansion that will offer comprehensive preventive and restorative dental care to low-income children up to the age of 20.
Of the 21 states that have submitted their plans to HCFA so far, at least 15 cover basic, preventive dental care.
Even states that aren't including dental coverage at the outset of their CHIPs are planning on adding it later. Colorado, for instance, has already made a decision to try to find funding for dental care in its program's second year of operation.
Of the 21 states that have submitted their plans to HCFA so far, at least 15 cover basic, preventive dental care. New York, one of the states that doesn't include dental in its current expansion plan, will offer it if Gov. George Pataki's budget proposal passes the state legislature.
Dental coverage "has been sort of a stepchild to other agendas," until now, said Dr. Carroll Player, chairman of the American Dental Association committee, which has been studying CHIP plans.
"Less than 1% of Medicaid dollars have been spent on children's dental care," Mr. Player said. "Yet 80% of the dental decay in this country is among 20% of our children-those living in or near poverty. That's exactly the children CHIP is targeting. Outside of ear infections and the common cold, dental problems are the third most common health problems for children."
That doesn't mean the ADA thinks CHIP has solved all the problems with dental care in government-funded health insurance.
"Medicaid plans in various states have woefully underfunded dental care," Mr. Player said. His home state of South Carolina reimburses just 30% of traditional dental fees. Several states have faced lawsuits to force them to increase dental reimbursements. In fact, it wasn't until California lost such a case in the early '90s that it began paying anything approaching normal and customary fees to dentists under its Medicaid program.
"It's been a slow process, but we've seen over the last six months that states have been able to get modest increases," Mr. Player said. "That's a big change."
That doesn't mean he's ready to declare victory on providing dental care to low-income children in CHIP states.
"It's really too early to tell," Mr. Player added. "It's really hard to tell until you see the implementation. We'll be better able to answer your question a year from now."
Contact Dr. Player at 803-669-5687, Mr. Grgurina 916-324-4695 or Ms. Emery at 916-443-0505.
Dental care, once the ignored stepchild of publicly-funded health insurance programs, has become a fundamental element of many plans submitted by states seeking to take advantage of new federal Title 21 funding for Child Health Insurance Programs.
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