ADA News

Washington—ADA-supported legislation would require states to provide "appropriate and necessary oral health benefits" to aged, blind or disabled persons who are Medicaid eligible. Under current law, adult dental services are optional under Medicaid and most states provide little or no coverage for these services.

The Special Care Dentistry Act of 2010, offered May 20 by Rep. Bart Stupak (D-Mich.) and referred to the Committee on Energy and Commerce, would require oral health coverage for the aged, blind and disabled through a separate state adult dental program.

H.R. 5346 would require in part: "The state shall demonstrate that the services and fees provided and program requirements under this section are at least equivalent to the services, fees and requirements that are provided to children under this title and include age-appropriate services for such individuals, and that the services are provided at intervals to determine the existence of a suspected illness or condition consistent with reasonable standards of dental practice (taking into account the increased needs and oral health complexities of the population) as determined by the [Health and Human Services] Secretary after consultation with national professional organizations."

The bill also would require transportation "to dental offices, hospitals, clinics or other treatment centers for the provision of oral health services to the same extent that transportation is provided under the state plan for children eligible for medical assistance."

The term "oral health services" is defined as meaning relief of pain and infections; restoration or replacement of teeth; periodontal treatment; dental health preventive services, including adult fluoride application; in-patient and out-patient dental surgical, evaluation and examination services; dentures or partial denture care; per patient house call and long term care facility visits; sedation and anesthesia, and behavior management services to accommodate physical or behavioral impairment.

Some 28 percent of Medicaid enrollees are classified as aged, blind or disabled.