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Exchange Delays Pediatric Dental Mandate

Covered California yesterday decided to hold off on embedding pediatric dental services in 2014 health plans offered by the exchange. In a special hearing convened for the single topic of pediatric dental benefits, the board unanimously voted yesterday to adopt a staff recommendation to delay the idea, and to target 2015 to implement an embedded policy. That includes an aggressive timetable for decisions about how to properly do that.

If the state insisted on soliciting dental plans to offer the embedded benefit, it would have had no takers, according to Peter Lee, executive director of Covered California.

“Health Net said they would have the capacity to do embedded plans, and [another plan said] that it was theoretically possible to offer embedded plans,” Lee said, but he added that those were the only two plans who might have been able to create an embedded plan in time for 2014, but both said they wouldn’t apply for it if the state solicited them.

“Might be able to do it and wanting to do it are separate issues,” Lee said.

Committee member Susan Kennedy summed it up this way:

“If we thought we could, we would,” she said. “It just is technically not feasible right now.”

Including an embedded pediatric dental plan would require that the benefit be included in all plans, spreading out the risk and hiking premiums in small increments for a large number of people, state officials said.

The board set a timetable for moving toward embedded dental coverage:

  • A draft analysis from Covered California staff by Oct. 15;
  • Sharing that draft with stakeholders in October and November;
  • Nov. 21 deadline for presenting a recommendation to the Covered California board; and
  • The board taking action on the staff recommendation by Dec. 19.

That schedule would allow the board to set policy and give enough time for plans to follow those policy decisions, Lee said.

“It’s the best we can do in the near- and the long-term,” he said, “to give us more latitude than we have today.”

Part of the research that needs to be done, Covered California staff members said, is figuring out how other states are handling pediatric dental services, and how they’re reconciling them with recent federal guidelines that allow the benefit to be carved out.

“All of the states seem to want to know what the other states are doing,” said James Mullen, manager of government affairs at Delta Dental of California. “And no one seems to know. We’ve been grappling with this issue with eight other states, and they all handle it differently. Affordability is a key component, but we want to look at all components of this issue.” 

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