Designing Dental

This article was written by Joanna Douglass, BDS, DDS, Consultant to the Connecticut Health Foundation.

Children from families with low-income and/or a racial and ethnic background are significantly more likely to get dental disease and typically much less likely to get dental care, according to the State of Connecticut Department of Public Health’s 2012 report, Every Smile Counts. In CT, African American and Hispanic children are more likely to have decay experience and untreated decay when compared to non-Hispanic White children.[1]

Within the Affordable Care Act (ACA), children whose families are purchasing commercial insurance through the health care exchanges are mandated to receive dental coverage. But is that enough?

The short answer is no. The Connecticut Health Foundation (CT Health) recently released a brief that examines the link between increased reimbursement rates for dentists under the HUSKY-A plan and adequate access to care. We encourage you to read the blog post and download the brief here. Overall, the data suggest that when HUSKY-A reimbursement rates were closer to those of private insurance, more dentists accepted children with HUSKY-A – and more children received treatment.

Increasing reimbursement rates, then, was a successful strategy for getting more children the dental care they needed. What can we learn from this to apply to dental coverage implementation in the ACA?

Consider what has been agreed upon:

  • Plan design

and what is still (at this point in time) up-in-the-air:

  • Out-of-pocket costs to families
  • Provider networks
  • Enrollment process

Access Health CT, the name of the Connecticut Health Insurance Exchange, is in the process of answering all these points in the race to have the exchange up and running by 2014. There is a critical opportunity for health equity rooted in how this plays out.

Plans sold on the exchange in CT will embed dental into medical plans for children. This means that when families purchase a medical plan, children will automatically have dental coverage. This removes a key barrier to care. If dental is included, children are more likely to go to the dentist, affording more children the opportunity for good oral health and by extension, good overall health.

Another benefit of an embedded plan is that cost-sharing measures, such as co-pays and coinsurance, would count against one out-of-pocket maximum (once that maximum is reached, the plan pays 100 percent of costs for the rest of the plan year). If dental is standalone, families will have an additional out-of-pocket maximum to reach, which could be as much as $1500.

The in-person assisters responsible for enrolling people into Access Health CT must be sufficiently trained to guide people through the enrollment process. That training must include the importance of good pediatric health and its impact on overall health for the long-term.

Enrollment materials will need to support a family’s decision-making process. Besides emphasizing the importance of dental coverage, they will need to be appropriately tailored to families with regard to language, reading level, and health literacy level. Meaning, they will need to be available in a variety of languages and easily understandable to people with varying knowledge of health insurance or reading ability.

Which brings us back to the issue of provider reimbursement. Access Health CT will need to supply plans with robust participating provider networks. If plans cannot offer attractive reimbursement rates to dentists, they will be much less likely to participate, and the network may not be adequate enough to provide services to families.

An all-inclusive plan, that satisfactorily reimburses dental providers, is our best bet for getting children to the dentist. Dental disease and dental pain is highly preventable through early and consistent interventions.  Making dental care readily available to families on the exchange is critical to preventing that disease.