2010
Medicaid/SCHIP Dental Association webinar. Reproduced with permission from the Medicaid/SCHIP Dental Association.
- Partnership for Oral Health Leadership established
Background
The Maternal and Child Health Bureau established Partnership for Oral Health Leadership (POHL) through cooperative agreements to support national membership organizations to provide direction to their leadership and members to improve oral health systems of care, especially those impacting access to the delivery of oral health services, for the maternal and child health population.
Impact
POHL funds were awarded to two national organizations, the Association of American Medical Colleges (AAMC) and the Medicaid-CHIP State Dental Association (MSDA). With this funding, AAMC developed a framework for a model curriculum compendium to provide online access to peer-reviewed teaching materials to assist medical faculty in integrating oral health into medical training. In addition, MSDA worked to strengthen the capacity of the Medicaid and Children’s Health Insurance Program financing infrastructure, integrated this infrastructure into the existing oral health infrastructure, and developed state-level policies and programs that demonstrate a coordinated and integrated systems approach to the delivery and administration of comprehensive school-based oral health care services.
Source
Maternal and Child Health Bureau. 2010. Partnership for Oral Health Leadership Program [guidance]. Rockville, MD: Maternal and Child Health Bureau.
- Patient Protection and Affordable Care Act signed into law
Background
In March 2010, President Barak Obama signed into law the Patient Protection and Affordable Care Act (ACA), enacting national comprehensive health reform. The ACA aims to improve access to health care and outcomes through a number of mechanisms, including requiring most individuals to have health insurance, prohibiting insurers from denying health insurance coverage based on preexisting conditions, creating exchanges through which individuals and families not eligible for employer- or government-sponsored health insurance may purchase coverage, and expanding eligibility requirements for Medicaid. The ACA includes several provisions related to oral health.
Impact
The new law makes children's oral health care an integral part of what is defined as an "essential benefits [EHB] package" that will be offered in state insurance exchanges as part of the health insurance marketplace beginning in 2014. The marketplace will allow individuals and small businesses to compare health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs like the Children's Health Insurance Program (CHIP), and enroll in a health plan that meets their needs. By 2017 oral health will be considered an EHB for all coverage, inside or outside the exchange system.
The ACA does not specify which tests, treatment, or services must be included in the EHBs. States select a benchmark plan for covered services. If that plan does not include pediatric oral health coverage, the benchmark is supplemented with the oral health services offered in either the state's CHIP plan or in the largest dental plan offered under the Federal Employee Dental and Vision Insurance Program.
Unless a state requires it, separate pediatric oral health coverage is not a required purchase inside the new exchanges. However, outside the exchanges, individuals purchasing individual or small-group coverage must purchases pediatric oral health coverage through their health plan or give "reasonable assurance" that they have purchased it through an exchange-certified stand-alone oral health plan.
Sources
Department of Health and Human Services. N.d. About the Affordable Care Act [website].
Children's Dental Health Project. 2013. FAQs: Pediatric Oral Health Services in the Affordable Care Act [website].
The Maternal and Child Health Library at Georgetown University. 2013. Patient Protection and Affordable Care Act (ACA): Resources for Professionals. Washington, DC: The Maternal and Child Health Library at Georgetown University.
Davis C, Heally C. 2012. Oral Health Care and the Affordable Care Act. St. Paul, MN: Network for Public Health Law.
Oral Health Watch. N.d. Healthcare Reform and Oral Health [website].
U.S. Department of Health and Human Services. 2014. Insurance Marketplace [website].
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