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ACA dental impact projections

July 12, 2012

By Craig Palmer, ADA News staff

Washington—Millions more children will have dental coverage in 2014 under the Affordable Care Act, according to an Association statement on the U.S. Supreme Court’s June 28 ruling. But any increase in dental Medicaid coverage of adults is likely “to be minimal.”

A 2011 ADA House of Delegates resolution called for a study of the impact of the Patient Protection and Affordable Care Act (or ACA) and the impact of projected marketplace changes on the dental profession. “The reports should be ready in the next few weeks, allowing the ADA to use actuarially-supported projections to help us create a more meaningful dental impact projection,” said the July 12 statement.

“The Supreme Court decision allows the federal government to move forward with ACA implementation, including the requirement that health care exchanges be in place in each state by January 1, 2014. As a result, millions more children will have dental coverage from private and public sector health plans in 2014,” the Association said.

“Prior to the Supreme Court’s decision, the ACA might have increased somewhat the number of Medicaid-eligible adults who received dental coverage. Because the court struck down a mandate that states cover adults up to 133 percent of the federal poverty level, we expect that increase in adult coverage to be minimal.

“While the Medicaid expansion for adults did not include a requirement for dental coverage, the states that choose to expand their programs must do so by using one of several benchmark plans, which might contain some dental coverage,” the Association said.

With regard to the ACA essential health benefit package, the Department of Health and Human Services Center for Consumer Information and Insurance Oversight is leaving that up to the states for now. CCIIO guidance offers flexibility by recommending that states choose from among certain benchmark plans. If the benchmark plan does not include pediatric oral health benefits the state must supplement the benchmark plan with one of several options, the Association said.

The ADA and the American Academy of Pediatric Dentistry met with CCIIO representatives June 13 to address ACA implementation if the federal government has to set up the exchange in a given state. “The agency made it clear that it will still try to bring state officials into the decision-making process,” the ADA said. “Presently, the primary action regarding implementation remains at the state level.”