Obamacare has unintended loophole in kids' dental care

Dental benefits for kids that were intended to be mandatory in the marketplace are, in fact, optional.
MCT Regional News
Dec 30, 2013

About one of every five third-graders in Ohio had untreated dental disease in 2009-10, down from one in four in 1998-99. • Despite that improvement, oral health remains the top unmet health need for Ohio’s children and low-income adults, according to a report released in November by the Ohio Department of Health and several partner organizations.

The Affordable Care Act was meant to address those needs by including pediatric dental care among 10 “essential health benefits,” a set of services that must be covered by certain plans beginning next month.

As a result of the law, as many as 8.7 million people younger than 21 are expected to gain coverage nationwide by 2018, an analysis funded by the American Dental Association found. An additional 17.7 million people who are at least 21 years old are expected to gain dental benefits, primarily through an expansion of Medicaid in many states.

For those who don’t have health coverage through their job or Medicaid and instead buy it directly from insurers, there are complications to keep in mind.

The law requires that pediatric dental benefits be offered through each state’s health-insurance marketplace, where people can shop and compare health coverage. But there is no requirement that consumers purchase those pediatric dental benefits if they are offered as a stand-alone dental plan and not as part of a medical plan.

In other words, dental benefits for kids that were intended to be mandatory in the marketplace are, in fact, optional.

In Ohio’s federally run marketplace, some medical plans include dental benefits, particularly for kids, but others don’t.

There’s another wrinkle: People who qualify for tax credits or cost-sharing subsidies that make their medical coverage more affordable don’t receive such assistance for stand-alone dental plans. What’s more, with stand-alone plans, there’s the potential for higher maximum out-of-pocket costs, though the federal government has a plan to reduce the current maximum of $700 per child to $300.

As a result, people who get dental coverage for their kids through stand-alone plans risk paying more than those who get that coverage through subsidized medical plans.

The law appears to have created the potential of “an unintended imbalance,” said Meg Booth, director of policy for the Children’s Dental Health Project, a Washington, D.C.-based nonprofit group that works on access to pediatric dental care and prevention of dental disease.

Advocates of pediatric dental benefits say they weren’t intended to be offered separately in the government-run marketplaces.

“We sometimes forget that our heads are attached to the rest of our bodies when it comes to the health-care system,” said Sandy Oxley, CEO of Voices for Ohio’s Children and co-chairwoman of the Children’s Oral Health Action Team in Ohio. She said mental-health benefits, like dental benefits, traditionally have been treated as afterthoughts.

Though children of poor families in Ohio already have coverage through Medicaid, the state’s pending expansion of the program bodes well for the oral health of kids.

“We know that the chances of children connecting to care increase 400 percent as their parents gain coverage,” said Julie DiRossi-King of the Children’s Oral Health Action Team in Ohio.

Regardless of the law, Nationwide Children’s Hospital is planning to expand its dental clinics to meet demand, said Dr. Paul Casamassimo, the hospital’s chief of dentistry.

The hospital is weighing several options, including adding a dental clinic at one of its primary-care facilities, providing mobile dental services or establishing a presence in an underserved area such as southeastern Ohio. A decision is expected in the next year or two, Casamassimo said.

The hospital’s dental-clinic operations lost about $2.6 million in 2012, in part because Medicaid reimbursement for dental services is low. Of the hospital’s dental-clinic patients, 73 percent are covered by Medicaid.


By Ben Sutherly - The Columbus Dispatch, Ohio (MCT)

©2013 The Columbus Dispatch (Columbus, Ohio)

Visit The Columbus Dispatch (Columbus, Ohio) at www.dispatch.com

Distributed by MCT Information Services



What else do our legislators expect when they had to pass this bill FIRST before they could find out what was in it? I am confident they will find MANY more loopholes before all is said and done.

Dr. Information

This is what happens when you rush things along and shove things down the voters throat without bipartisan support and suggestions. The Dems have had long enough control of Washington and have proven one thing, they don't know how to run this country. Time for some real change.


Re: "Time for some real change."


It would be great to throw out BOTH the progressive-socialists and the country club Repubs. Too much east coast liberal mentality stinking up Washington.

Unfortunately, there's little chance for it to happen until after this country goes over the fiscal cliff.

In the meantime, give Americans an increasing amount of potentially unfunded liabilities with more and more "cradle to grave" "common sense" social programs like dental care along with guaranteed food, clothing, housing, jobs and cell phones!

Where the 'kind hearted' Soviets financially crashed, burned and died, the American progressive-socialists are 'smarter' and can succeed. lol.

Cliff Cannon

@ Contango : Amen !

We are most certainly headed for the " New Frontier " that President Kennedy spoke of. Of course, he said ; " The New Frontier of which I speak, is not a set of promises---it is a set of challenges. It sums up, not what I intend to offer the American people,but what I intend to ask of them "

This 'New Frontier ' that we face. Obviously, does not intend to draw on Americans legendary courage to face challenges,then solve problems. Rather, it draws on the natural human inclination to take the easiest path to ease and comfort.

That path, of course, destroys more nations than any war ( short of nuclear ) could. Which leaves, but one question : " Why ? "


President Obama has promised 2014 to be a "year of action". Heaven help us all!


Why does the news always report the BAD as "UNINTENDED" when it comes to Obama?..
does anyone NOT think our government could be working a master plan of "control" ..period.
Or would that just be in history books, fables, tales. Surely not in modern times?... We're way to intelligent of a species? right?


Funny how medicaid covers "dental", but medicare doesn't. It also covers vision while medicare doesn't, unless it is because of a health related illness like diabetes. Seems to me, since people have to pay for medicare, that they should at least have the same coverage as the ones who don't pay.

swiss cheese kat's picture
swiss cheese kat

Obamacare will be a spectacular failure.


@Windy Agreed.........