The U.S. Senate released its health care reform proposal on June 22, 2017. The American Academy of Pediatric Dentistry (AAPD) has been advocating to Congress since the 2010 passage of the Affordable Care Act (ACA) to improve provisions in that law to enhance children’s oral health coverage. See: http://www.aapd.org/assets/1/7/2017_ACA_Replace_or_Repair_Fact_Sheet.pdf

Recently, the AAPD joined the ADA and over 40 other national associations or organizations to highlight key priorities in 2017 health care reform legislation. Specifically, the letter emphasizes the importance of the Medicaid guarantee of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) for children’s dental coverage, and retaining children’s pediatric oral health care as an essential health benefit. For a copy of the letter click here. The AAPD also plans additional follow-up efforts responding to the details in the Senate proposal. On June 26, 2017 the AAPD joined a coalition of dental organizations writing to key Senate and House committee chairs and ranking members asking that the pediatric oral health essential health benefit provision in the ACA be retained. View the Congressional letter here. 

A useful side-by-side comparison of the ACA, House bill, and Senate proposal, is available here.

The AAPD is especially focused on the following provisions:

"ACA requirement to cover 10 essential health benefit categories is not changed; however, the 1332 waiver authority is amended to make it easier for states to eliminate or change the essential health benefits standard for health insurance coverage offered in the individual or small group market."

The concern is that states might drop EHB pediatric oral health coverage requirements under such waivers.

"Convert federal Medicaid financing to a per capita cap beginning in FY 2020.

Set total medical assistance expenditures for a state as the sum of the per enrollee amounts for five groups–elderly, blind and disabled, children, expansion adults, and other adults–multiplied by the number of enrollees in each group. (For states opting to adopt the Medicaid expansion after FY 2016, the per enrollee amount for this group would be the same as the other adult group under the per capita cap)."

While EPSDT is not specifically mentioned, concern remains over the ability to fulfill the EPSDT requirement under a reduced funding scenario.

For further information, please contact AAPD Chief Operating Officer and General Counsel C. Scott Litch at slitch@aapd.org.