ADA supports eliminating waiting, lockout periods for dental care in CHIP

Association also offers suggestions on ways to improve provider enrollment in Medicaid, CHIP

The ADA is sharing ways the Centers for Medicare & Medicaid Services can simplify the processes for individuals to enroll and retain eligibility in Medicaid and CHIP, including eliminating limits on dental care.

In comments filed Nov. 4 in response to a proposed rule from the agency, ADA President George R. Shepley, D.D.S., and Raymond A. Cohlmia, D.D.S., offered several suggestions on how CMS could smooth transitions between Medicaid and CHIP enrollees to keep enrollees from churning on and off the program. They also cited Kaiser Family Foundation data which estimated that prior to COVID-19, 10% of Medicaid/CHIP enrollees used to dis-enroll and re-enroll within one year.

“As of 2021, an estimated 7.3 million individuals were uninsured but eligible for Medicaid coverage,” Drs. Shepley and Cohlmia wrote. “Seeking to close that gap without attempting to increase provider participation could have unintended and unsuccessful results for both providers and enrollees.”

The ADA urged CMS to avoid this by expanding dental participation in Medicaid by increasing reimbursement and reducing administrative burdens such as the easement of credentialing, audit processes and encouragement of clean claims paid within 15 days.

Regarding accessing CHIP coverage, the ADA applauded CMS’ proposal to eliminate waiting and lock-out periods for dental care within the program.

“While states do in many cases maintain separate CHIP programs that have over the years maintained waiting or lock-out periods, the trend of eliminating them in recent years has also corresponded to an increase in the utilization of dental services among all children, including by race,” Drs. Shepley and Cohlmia wrote.

Follow all of the ADA’s advocacy efforts at ADA.org/Advocacy.