Children from low-income families eligible to receive dental care under the Patient Protection and Affordable Care Act (PPACA) may not be able to take advantage of these benefits as easily as hoped. Although pediatric dental coverage rules are set to come out this week, the Wall Street Journal is reporting out-of pocket premiums may prevent parents from being able to afford dental care for their children.
Children receiving dental benefits via Medicaid and the Children’s Health Insurance Program (CHIP) will still have access to them under the 2010 health law, however children who are low-income but ineligible for coverage under these programs will have to access dental care via exchange coverage, experts say. Dental plans may be bundled with health coverage but may also be purchased separately.
Low-income families will receive subsidies that will help to cover the costs of premiums on a sliding scale of up to 400% of the federal poverty level, the WSJ reports. But the dollar amounts low-income families will get toward dental premiums have yet to be released.
Jennifer Tolbert, associate director with the Kaiser Foundation Commission on Medicaid and the Uninsured, says it’s unclear how the subsidies for low-income families will be allocated across medical plans both in and out of health-care exchanges.
“Through the exchanges, children who are eligible for Medicaid and CHIP today will remain eligible,” Tolbert says. “But there is still a lot we don’t know. The affordability of insurance in and outside of exchanges remains a concern.”
The president’s sweeping health-care reform has shifted the importance of dental and oral health into the spotlight, says Julia Paradise, principal policy analyst at the Kaiser Foundation.
“The Affordable Care Act brings dental right into the picture and establishes that it is essential to overall health,” Paradise says. “For a long time dental has been out of the picture, and going back about 10 years, there has been an increasing understanding of the importance of it.”
A 2010 Kaiser study found 80% of low-income children had recently had a visit to the dentist and the rate for children on Medicaid was slightly higher, Paradise says, because their costs out of pocket are lower than privately-insured and uninsured kids.
Even families that receive dental insurance through their employers will have a separate premium for dental care under the ACA, she says. However, she adds that regardless of premiums and subsidies is also an issue in low-income areas.
“There are still problems with access to dental care that have to do with provider participation in the program. It is difficult in underserved areas [to receive care] by definition.”