Results tagged “Dental”

Mom: "Did you brush your teeth?"

Child: "Yep."

Mom: "How come your toothbrush isn't wet?"

This is an excerpt from the script of the bedtime drama performed live nightly in the comfort of my own home.  Just between you, me and the tooth fairy ... after battling on the nutrition, hygiene and homework fronts, I don't have a lot of energy left to wage the toothbrush wars.  That's why I'm always a bit nervous about dragging my children to their 6-month dental check-ups.  Luckily, we have good dental benefits and an understanding dentist.  With the help of the dentist and dental hygienists, we've managed to get through with only a couple of cavities between all three kids.  (The nightly drama slacks off a bit after a good "education session" from the dentist.)

Other parents are facing the same obstacles to ensuring their kids have healthy teeth and gums but not all of them are able to rely on a dentist.   Even children with excellent brushing and flossing habits need to see a dentist because untreated dental disease and tooth decay can have devastating health consequences.  However, about one in five children in the U.S. do not receive dental care each year according to a new report The Cost of Delay: State Dental Policies Fail One in Five Children, by the Pew Center on the States.  The report points out that states play a key role in ensuring that low-income children have access to basic, preventive dental care and that more than two-thirds of the states are doing a poor job in this area.

The good news is that the Children's Health Insurance Program Reauthorization Act  provided states with new tools to help improve the oral health of children.  All CHIP programs are now required to cover comprehensive dental benefits. CHIPRA also allows states with separate CHIP programs to offer a dental-only plan for children who have other health insurance, but lack adequate dental benefits. Other oral health improvements include education for new parents, better access to benefit and provider information, and enhanced reporting on the quality of dental health services in Medicaid and CHIP.  CCF, the Kaiser Commission on Medicaid and the Uninsured, and the Children's Dental Health Project just released a "CHIP Tip" on CHIPRA's oral health provisions which is a good resource for those who want to see children receive better oral healthcare coverage.

 

As we all follow the twists and turns of health care reform in Congress, it's easy to forget that the critical children's health legislation that's already been passed this year--CHIPRA--is well on its way to being implemented.  CMS Medicaid and State Operations Director Cindy Mann (CCF's former fearless leader) took the time this week to update child health advocates on recent CMS actions and guidance on CHIPRA.  She highlighted that $10 million in outreach grants to tribal groups will soon be distributed.  She also passed on news that new guidance will soon be released on a variety of topics and was able to share several updates on issues raised by the new law:

• On dental coverage for kids:
• Dental provider lists are now available for each state at www.insurekidsnow.gov, but it sounds like there will be efforts to improve the quality and accessibility of these lists in the months ahead.  
• No state has submitted a plan amendment to alter its dental coverage in response to CHIPRA, but CMS has been talking individually to states. CMS also clarified that states won't be deemed out of compliance with the new dental benefits until it has officially promulgated regulations.
• The children of state employees can't be eligible for a CHIP-financed dental wrap-around, just as they are not eligible for CHIP itself.
• On the new option to drop the 5-year waiting period for lawfully residing immigrant kids and pregnant women in Medicaid and CHIP:
• The new option applies to children and pregnant women "lawfully residing" in the U.S., which is a broader category than the "qualified aliens" which the 5-year waiting period referenced. CMS is working with other agencies to develop an accurate definition.
• Eighteen states have plan amendments pending to exercise the new option; one state has been approved to date.  (Most of these states already use their own money to cover lawfully residing immigrant kids and pregnant women during the 5-year waiting period, but might have rolled back in the absence of the new federal help.)
• No "skipping" over Medicaid - states can't decide to cover lawfully residing immigrant kids and pregnant women in CHIP, but continue to impose the 5-year bar in Medicaid. 
• If a state does lift the 5-year bar in Medicaid, the good news is that it can secure the enhanced CHIP matching rate for the cost of covering these kids in Medicaid through the end of the 5-year period.
  
• On citizenship documentation
• CMS is moving quickly to test Social Security Number matching with the Social Security Administration and expects to have a matching system ready by January 1 for states that choose to use this option to document applicants' citizenship.
• On performance bonuses
• CMS is currently evaluating 18 states' applications for performance bonus funds; states may continue to apply.  The awards are expected to be announced by mid-December.
  

CMS released the latest in a series of state health official letters providing guidance on CHIPRA implementation. This seventh letter focuses on the new mandatory dental provisions for separate CHIP programs, as well as the option these states have to provide a stand-alone dental plan to children who are insured or underinsured but would otherwise qualify for CHIP. Both provisions are effective October 1, 2009. These provisions do not impact states that provide CHIP coverage through a Medicaid expansion program.

The addition of dental standards is considered one of the victories in CHIPRA since receiving dental care is without a doubt critical to the healthy development of children. With tooth decay as the most prevalent childhood infectious disease, the omission of mandated dental coverage in CHIP has been a significant oversight.

Although all states provided some level of dental services in CHIP there were often service or dollar limitations. Now states must provide "coverage of dental services necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions." States have two options for providing this coverage:

• States can translate this requirement into a defined set of benefits that includes medically necessary services within specific categories. This may prove a bit tricky as the burden is on states to demonstrate that their package meets the intent of the statute.

• Alternatively, states can provide benefits equal to one of three benchmark plans: either the dental coverage in the most popular federal or state employee plan, or the state commercial plan with the highest non-Medicaid enrollment. Note that there is no option for proving actuarial equivalence (as there is for CHIP medical benefits).
  

Regardless of the option chosen, the cost-sharing requirements must meet CHIP rules. States cannot impose cost-sharing for preventive and diagnostic services and the cost-sharing for both medical and dental services can be no more than 5% of family income.  

States also now have the option to provide a stand-alone dental plan for children who are income-eligible for CHIP but who have private medical coverage that has limited or no dental benefits. States that elect to offer this coverage must offer the same (and not more favorable) dental benefit plan as is provided to CHIP enrollees. For children with some dental coverage, this plan can serve as a "wrap," filling in gaps as a secondary payer to their private coverage. In order to offer a stand-alone plan, states must not maintain a waiting list or set a numerical limitation on the number of children enrolled in CHIP. In addition, the 5% cost-sharing cap on total medical and dental services also applies, which may represent a challenge since the state may not have access to information about a family's cost-sharing in their private insurance. As such, this may present a sizeable administrative barrier.

Despite the recent guidance, some questions remain. For example, must cost-sharing above any aggregate or maximum cap on benefits (as are common in commercial plans) be counted toward the 5% maximum cost-sharing? While the provisions are effective October 1, 2009, are states with pre-existing managed care plans required to modify their current contracts to come into compliance immediately or at contract renewal? As is common with federal policy, we continue to peel back the multiple layers of intepretation in search of definitive answers states need to fulfill the promise of CHIPRA.