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Maine bill seeks to eliminate insurance waiting periods for kids

Legislature will also consider adult Medicaid dental benefit

December 03, 2019

By Jennifer Garvin

Shenkin
Dr. Shenkin
Portland, Maine — A new bill aims to eliminate insurance waiting periods for children to receive dental care in Maine.

LR 2910, An Act to Facilitate Dental Treatment for Children, would enable children with private dental insurance to receive care without having to wait up to several months for coverage to start.  

The bill, which does not include orthodontic treatment, was introduced last month by Sen. Heather Sanborn, D-Portland.

According to bill language, the bill requires that dental benefit plans “offering coverage in the group or individual market shall not impose a benefit waiting period on any dental or oral health service or treatment for enrolled individuals” 18 and under.

“As a small business owner who provides health benefits to my employees, I expect that those benefits will cover the urgent needs of my employees and their families,” Sen. Sanborn said. “Forcing a child who has tooth decay to wait for months before it can be dealt with (or forcing an insured parent to pay out of pocket in order to get timely access) is deeply disturbing to me. In the end, rather than controlling costs, these delays may actually drive them up. This bill seems like an important first step in ensuring that insurance companies are covering needed care in a timely manner.”

Dr. Jonathan Shenkin, a pediatric dentist practicing in Augusta, said currently, most families with private dental insurance wait an average of three to 12 months after signing up for a plan. He hopes the bill will pass when the legislature reconvenes in January.

“After nearly two decades of efforts to improve oral health for children in the U.S., this is another effort to shore up the oral health infrastructure for children,” he said.

In a Dec. 2 op-ed published in the Portland Press Herald, Dr. Shenkin, a former ADA vice president and past president of the Maine Dental Association, said the bill makes Maine the first state to try to eliminate pediatric waiting periods.

“No state in the nation has attempted to address this misappropriation of care until now,” he wrote.

Dr. Shenkin also said that MaineCare, the state’s Medicaid program, has “always provided immediate coverage for dental treatment for eligible children” and noted private insurers have had waiting periods for treatment for decades.

“This puts timely dental care out of reach for many children, particularly those whose families earn just a little more than the threshold for MaineCare eligibility.”

Maine also looks at adult dental benefit in Medicaid

The Maine legislature will also consider a bill to establish more comprehensive dental care for adult MaineCare beneficiaries.

LD 1453, An Act to Improve Dental Health for Maine Children and Adults with Low Incomes, was introduced by Rep. Drew Gattine, D-Westbrook. Adult enrollees are limited to coverage for dental emergencies only, under the current program. The bill would add “access to comprehensive medically necessary preventive, diagnostic and restorative dental services” and also establish a dental incentive payment program for dentists to increase access to dental care for MaineCare members.

The ADA can help dentists with dental benefits-related and coding problems, questions and concerns. Call the ADA's Third Party Payer Concierge at 1-800-621-8099 or email dentalbenefits@ada.org.  Additional dental benefit resources can be found at ADA.org/dentalbenefits.