To Make Dental Coverage Meaningful, You Need a Robust Network of Dentists
This article was written by Colin Reusch, Senior Policy Analyst for the Children’s Dental Health Project (CDHP). CDHP is a grantee of the Connecticut Health Foundation.
Simply offering coverage is not enough to ensure that a patient gets the care they need when they need it. First a patient must find a dentist who not only accepts their insurance but also has an office location within a reasonable travel distance. In traditionally underserved communities, whether they be rural or urban, finding such a dentist is not always easy and getting to one can often be trickier. According to the Health Resources and Services Administration (HRSA), Connecticut has 37 dental professional shortage areas (areas where there are 5,000 or more people per dentist) across its eight counties. Low-income families enrolled in Connecticut’s HUSKY (Healthcare for UninSured Kids and Youth) program know this all too well, as Connecticut has only recently acted to improve access to dental care in these programs.
A lawsuit alleging the state had failed to provide adequate access to dental care in the HUSKY program resulted in a 2008 settlement that included a host of reforms, among them standards for provider network adequacy. In total, the requirements imposed by this settlement proved incredibly beneficial to HUSKY families, showing a 30% increase in utilization of dental services over the course of four years. Given that a more robust provider network led to more children getting care, we want to spread this success to the implementation of the Affordable Care Act (ACA).
Open enrollment begins October 1, 2013, at which point many previously uninsured Connecticut families will be able to purchase health coverage with the support of federal subsidies available through the ACA. Access Health CT, Connecticut’s new health insurance marketplace, will offer insurance plans that must cover a set of essential services, including children’s dental care. The Connecticut Health Foundation (CT Health) has been working since the ACA passed to ensure that children and families are able to make the most of these new benefits. Most recently, CT Health asked Access Health CT to set specific standards for plans providing dental coverage so that families are able to easily find and access dental providers for their children. In recommending dental access standards to Access Health CT, it only made sense for CT Health to base its recommendations on the HUSKY model of success.
While the ACA does attempt to ensure that families have adequate access to all covered services, the regulations governing these requirements fall short when it comes to dental benefits, simply referencing existing national standards for health insurers. Unfortunately, no such standards exist for dental insurers, and state marketplaces are unlikely to go above and beyond the federal statute without further guidance. As a result, it has fallen on state advocates to take the lead in encouraging dental access requirements in the new health insurance marketplaces.
Building on the standards outlined in the 2008 settlement, CT Health has recommended to Access Health CT in a memorandum that they require all plans providing dental coverage to have:
- a provider network robust enough to ensure that families requesting non-emergency dental care can get an appointment in eight weeks’ time,
- a provider available within a 20 mile radius, and that patients have access to necessary dental specialists within 50 miles.
- emergency dental care provided to patients in no more than two business days after they request an appointment.
The ACA also created a new class of providers focusing on underserved areas. These essential community providers (ECPs) include clinics like community health centers which typically see patients who are uninsured or who otherwise are unable to find the care they need. Unfortunately, the law does not require dental plans to include ECPs in their provider networks. Because the availability of these providers is critical to ensuring equitable access to care in Connecticut, CT Health has also urged Access Health CT to consider whether dental plans include ECPs in their networks when evaluating plans for the purpose of determining whether they are qualified to provide coverage in the marketplace.
In including pediatric dental services as part of the benefits package in the ACA, Congress recognized that oral health is essential to an individual’s overall health. Accordingly, the same standards for quality and availability of care should apply to all plans offering coverage through Access Health CT. Every person in Connecticut, regardless of income, color, or where they live, deserves to have equal access to quality dental care. As we continue the work necessary to implement the ACA and expand coverage across the state, we must not lose sight of the importance of not only having dental coverage but also being able to get care without delay.
Douglass BDS, DDS, Joanna. “How Connecticut Got More Kids Smiling,” Shaking the Foundation – Blog, September 17, 2013.http://www.cthealth.org/blog/how-connecticut-got-more-kids-smiling/
 Nasseh, Kamyar, and Vujicic, Marko. “Reconnecting Mouth And Body: ACA Fails To Meet Dental Care Needs But States Can Pick Up Slack,” Health Affairs Blog, September 17, 2013. http://healthaffairs.org/blog/2013/08/26/reconnecting-mouth-and-body-aca-fails-to-meet-dental-care-needs-but-states-can-pick-up-slack/