Friday, January 04, 2013

ObamaCare in Dentistry: California and Washington Mandate Pediatric Dentistry in Health Exchanges

Beginning in 2014, Californians and Washington State residents will be mandated to purchase pediatric dental service insurance, according to this post in Medscape.

The states of California and Washington will require people who buy medical insurance through new health plan exchanges to also buy pediatric dental benefits regardless of whether they have children, according to official documents and interviews.

The new requirements will kick in on January 1, 2014, as part of the states' implementation of the federal Affordable Care Act.

Together the 2 states are offering some of the first responses to a conundrum embedded in the new law: Although the law requires everyone to have health insurance or pay a penalty, it exempts dental benefits from this "individual mandate." However, it lists pediatric oral health services among the 10 "essential benefits" that health plans must include when sold to small groups, such as businesses with 50 or fewer employees, and to individuals. In addition, it allows dental plans to be sold separately from medical plans in state health insurance exchanges that the law sets up.

These somewhat contradictory provisions have left dental policy experts wondering whether anyone will be required to get dental benefits at all, and so far, the US Department of Health and Human Services, which is charged with issuing regulations under the new law, has declined to offer guidance.

With only a year to get the new exchanges going, California and Washington have now reached their own decisions about the pediatric benefit.

However, in other states, it is not so certain.

Some states have decided to not establish their own health exchanges, but have the federal government do so.

About half the states have indicated they will not create their own health plan exchanges, said Reusch. Under the Affordable Care Act, the federal government will set up exchanges for any states that do not create their own. It is still not clear whether the federally run exchanges will also force consumers to purchase pediatric dental benefits.

The act is also unclear about whether stand-alone pediatric dental benefits sold to small-group customers outside the exchanges can meet the requirements of the act; one interpretation of the law is that pediatric benefits must be folded into medical plans when the plans are sold in the small-group market outside the exchanges.

There is no requirement that large groups, such as businesses with more than 50 employees, include pediatric oral health benefits, although many already offer such dental plans.

There will be an increasing need for pediatric dentists in California and Washington - that is a certainty. But, whether these specialist dentists or general practitioners will be able to increase their capacity to see all of the patients is uncertain.

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