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Groups ‘remain concerned’ about CMS waivers, ask agency not to implement upcoming guidance

July 03, 2019

By Jennifer Garvin

Baltimore — In response to the Centers for Medicare and Medicaid Services’ Request for Information on state relief empowerment waivers, the ADA, American Academy of Pediatric Dentistry and Children’s Dental Health Project said they remain concerned that the agency’s waiver guidance could adversely impact children’s access to oral health care and urged the agency not to implement the guidance.

In October 2018, CMS announced four 1332 waiver concepts designed to empower states to come up with better health care solutions for their residents. ADA, AAPD and CDHP expressed support in a December letter for the concept of providing states with more flexibility but also shared their collective concern that the guidance may weaken the Affordable Care Act’s Essential Health Benefits — also known as EHBs. The stakeholders said they were particularly worried that the guidance will weaken the ACA’s comprehensive oral health benefit for children.

They shared those concerns again in a June 28 letter to the agency. They pointed out that “under the ACA guardrails in Section 1332, a state’s plan waiver must provide comprehensive health coverage to at least as many residents as would have coverage without the waiver,” noting that the 2018 guidance doesn’t include that protection.

The three organizations also said they are concerned about the waiver concepts outlined in CMS’ Request for Information, including the adjusted plan options.

“Allowing states to provide financial assistance for coverage which does not adequately meet the needs of children and families, including meaningful dental benefits, could limit children’s access to dental care,” they wrote. “Additionally, we think that allowing states to align Section 1332 waivers with 1115 Medicaid waivers could threaten children’s coverage under the Medicaid and Children’s Health Insurance Programs.”

Citing ADA Health Policy Institute research, they noted that since 2015, the percentage of children with dental coverage has reached an all-time high. They also shared studies from the American Journal of Public Health and Journal of Dental Research that found evidence that oral health impacts school performance and employability.

“Children without dental benefits are more likely to seek care in hospital emergency rooms. However, dental disease is largely preventable, and consistent access to early interventions and treatment can help children achieve optimum health while minimizing cost throughout the lifespan,” the groups wrote.

The letter concluded with ADA, AAPD, and CDHP urging CMS to “better protect children’s dental health” by not implementing the waiver concepts outlined in the Request for Information.

“The inclusion of pediatric dental coverage as an EHB was a victory for children. We respectfully encourage the agency to work collaboratively with us to identify other potential reforms to reduce costs and improve care,” they said.