Broker blog from Delta Dental

Tag: Medicaid

The 2020 elections and the Democrats’ clean sweep: What’s at stake for dental insurance

In an earlier Insider Update article, we considered three possible outcomes of the 2020 United States elections and some possible implications of each.

Since then, the Democratic Party has gained control of the Senate, while winning the White House and keeping control (just barely) of the House of Representatives.

From the Delta Dental perspective, this “clean sweep” impacts all our stakeholders, including dentists, enrollees and our group customers. What follows are some potential opportunities and challenges that may affect you.

The Affordable Care Act (ACA) and the health insurance marketplace (exchange) system will be preserved and expanded

President Joe Biden’s administration has made restoring the ACA an immediate priority, and many of the cuts and restrictions imposed by the administration of former President Donald Trump are being reversed.

This is a positive development for the dental industry, said Jeff Album, Vice President of Public & Government Affairs for Delta Dental.

“News that’s good for the ACA and good for the exchanges is good news for the industry,” Album said. “This market and the increased subsidies attract people who wouldn’t otherwise get insurance.”

Among the ACA-related actions that are either underway or soon to happen under this administration:

A special enrollment period to increase exchange enrollment is officially underway

Biden signed an executive order to create a special enrollment period from February 15, 2021 through May 15, 2021, during which eligible people can enroll in coverage from the federal health insurance marketplace. Uninsured residents in the 36 states that use the federal exchange system, including those who lost coverage because of the pandemic, can look for plans.

States with their own marketplaces are also creating special enrollment periods, although the time frames and eligibility requirements may differ.

The Centers for Medicare & Medicaid Services (CMS) has earmarked $50 million for outreach and education during the enrollment period.

The ACA’s Navigator Program will return

Reversing the prior administration’s move to defund this program, CMS will now provide about $2.3 million to help people find coverage on the federal exchanges, a process that can be confusing. The money will fund 30 Navigator Programs in 28 states. This, Album said, should help bolster dental enrollment.

“Several studies suggests that consumers are completely unaware of marketplace open enrollment dates, including the special enrollment periods,” Album said. “We believe this type of outreach will definitely help promote adult dental voluntary enrollment.”

Subsidies for exchanges will increase

The $1.9 trillion American Rescue Plan Act of 2021 (ARP), which Biden signed into law on March 11, includes increases to ACA subsidies. Consumers with household income more than 400% the federal poverty threshold (about $51,000 per year) will receive federal assistance to ensure that no more than 8.5% of their income goes toward a plan.

“The subsidies are getting better and the Biden administration is trying to bring more people into the exchanges,” Album said. “A great many small business and individuals impacted by the economy and COVID will now have an opportunity to get exchange-based dental coverage.”

Waivers that allow states to circumvent exchanges may be eliminated

Section 1332 of the ACA permits states to apply for a waiver to pursue “innovative strategies” to provide their residents with access to affordable health insurance, so long as they retain the basic protections of the ACA.

However, in 2020, the state of Georgia used the 1332 waiver to effectively eliminate its exchange program and force Georgia residents to purchase plans from private insurers without any kind of centralized platform. As a result, Biden directed federal agencies to reexamine all waiver policies, including 1332.

“I think this administration is going to be tougher than the former one when it comes to deviating from the ACA’s framework,” Album said. “We’re not likely to see any other states attempt a direct enrollment alternative to centralized state-based exchanges or the federally facilitated exchange.”

Medicaid eligibility under the ACA will expand

The ARP also includes incentives to encourage states to expand Medicaid eligibility under the ACA. States that choose to expand would receive a 5‑percentage-point increase in Federal Medical Assistance Percentage (FMAP) payments to current Medicaid enrollees.

“The FMAP increases are important because that’s what allows states to do optional benefits like adult dental,” Album said. “Here in California, the adult dental Medicaid program was going to be in trouble if the state didn’t receive more financial assistance.”

A “public option” with a dental benefit could be created — but probably won’t

A public option would be a federal health insurance program offered on states’ exchanges as an alternative to private plans. It would probably be subsidized for lower income Americans and at least partially paid for by enrollees who don’t qualify for subsidies.

While dental coverage wouldn’t be a guaranteed benefit for anyone other than children, it could be made available on a voluntary basis.

Initially, it seemed as though a clean sweep by the Democrats would almost guarantee a public option. Candidate Biden repeatedly said he supported it during his 2020 campaign. And California Attorney General Xavier Becerra, Biden’s pick for Secretary of the U.S. Department of Health and Human Services and a long-time proponent single payer health care, said during a recent Senate hearing that he would support Biden’s efforts to do so.

However, the Democratic sweep in the 2020 election might not be enough to push this through. Despite their control of the Senate, the Democrats depend on the tie-breaking vote of Vice President Kamala Harris. Furthermore, the Democratic majority in the House narrowed significantly, which increases the leverage of moderate Democrats who aren’t enamored with the public option.

“Given the Democrats’ razor-thin majority in both the Senate and the House, and Republican opposition to the concept, a public option currently seems unlikely,” Album said. “I don’t see it happening.”

Leaving the ACA, here are a few other possible issues likely to come up for Congress and the new administration to consider that may potentially impact dental insurance.

A dental benefit could be added to Medicare

Democrats in the House and Senate have introduced bills to add dental under Medicare Part B. As introduced, these bills do not specify which benefits should be added, which makes it difficult to assess whether the proposals help or hurt existing Medicare Advantage dental plans.

“Neither the House nor the Senate is likely to take these bills up in earnest until the latter half of the year,” Album said, “but our goal will be to participate in discussions yet to come on how the industry can help facilitate bringing dental care to seniors without disrupting existing, successful programs.”

Questions remain

As with any new administration, there are more questions than answers at this point, and how — or if — some of these proposed changes will be implemented is uncertain. What is certain, however, is that we can expect more proposals and policy updates that will affect the dental insurance industry in the upcoming months. Be sure to refer back to Insider Update for news and updates as they become available.

Pediatric dentistry trends in 2021: How COVID-19 has affected children’s oral health

From work to school to every errand in between, the pandemic has affected just about every aspect of daily life, and as we’ve heard over and over again, children are struggling to keep up. As NBC News reports, grades are slipping and absenteeism is soaring. Sadly, and perhaps unsurprisingly, that absenteeism has also surfaced in other cornerstones of child development, including basic health care checkups.

Dropping numbers

Pediatric dental services were down 69% between March and May of 2020 year over year, according to the Centers for Medicare & Medicaid Services. During this time, of course, many practices had temporarily closed their doors. The numbers began to bounce back in May but are still lower than average. Delta Dental of California and its affiliates saw nearly a 10% drop in enrollees between the ages of 3 and 18 receiving exams or dental service from 2019 to 2020.

So, why the low turnout? A few reasons:

  • Apprehensions due to the pandemic. Perhaps the most obvious answer here, but a significant factor, nonetheless. Despite the many precautions taken by health professionals, some parents are still uncomfortable leaving their bubbles just yet. A majority of Americans spent the 2020 portion of the pandemic fearful of contracting the virus, according to a YouGov study. For at-risk parents with few other options, skipping out on these errands can be their only choice.
  • Limited options. With months of closures and capacities limited, simply securing an appointment can be difficult, never mind one at a convenient time. Balancing a home that is suddenly now an office and a school can leave few options for exhausted parents to get their children in the dentist’s chair. Additionally, needed care that might’ve been detected in a school clinic setting may go unnoticed with so many schools still closed. Medicaid beneficiaries are even more likely to struggle with these limitations, according to a poll by C.S. Mott Children’s Hospital at the University of Michigan.
  • Low priority. While small dental procedures are sometimes seen as easy to put off for children who still have baby teeth, there can be long-term effects. Left untreated, cavities can turn to abscesses or hinder the growth of healthy adult teeth.
  • Socioeconomic status. Perhaps the most concerning trend, however, is that of the deepening inequities in health care. The number of children without insurance hit a historic high in 2016 – well before the pandemic hit – and has continued to rise steadily since then, according to a study by Georgetown University. The pandemic, of course, has only exacerbated these issues.

Health care and wealth gaps

As the wealth and health care gap widens due to the pandemic, so do the many ways that such disparities trickle down to the nation’s children. According to the Journal of the American Dental Association, some of the biggest setbacks include:

  • Food deserts. Lack of healthy food options disproportionately affects low-income communities and nearly half of all students rely on free or reduced-price lunches. With schools closed, many families are forced to choose cheap and unhealthy options
  • Unprecedented job loss. With unemployment on the rise, so is lack of insurance or gaps in coverage. For unemployed or underemployed parents, losing employer sponsored coverage can mean unaffordable out-of-pocket costs for themselves and their children. Roughly 6.3% of the U.S. population remains unemployed, as reported in February 2021 by the Bureau of Labor Statistics.
  • Vicious cycle. A 2020 study by the Journal of Dental Research indicated that nearly half of the people who lost dental insurance during the pandemic will likely remain uninsured. This number is estimated to be even higher in states without Medicaid expansion.

Delta Dental and pediatric care

Delta Dental has been making strides to improve health and give back to our young and at-risk neighbors. In 2019, the Delta Dental Community Care Foundation provided nearly $20 million in funding to community organizations ranging from health centers to food banks. Many of the grant recipients are focused on pediatric health, including the Children’s Medical Center Foundation in Dallas, Texas, Family Health Centers of Southwest Florida in Ft Myers, Florida and Healthy Smiles for Kids (HSK) of Orange County, California.

In 2019, the Foundation funded a program through HSK called Prevention, Outreach, Education and Teledentistry (POET), which helps kids receive a comprehensive six-month dental check-up at their school, pediatric office or community sites. With this funding, the program was able to care for more than 25,000 underserved children.

Additionally, Delta Dental launched new teledentistry options this year, including an app called Toothpic. The program is intended to help patients, especially those struggling to make appointments, such as busy parents, get advice from a licensed dentist without leaving home or having to make a real-time appointment. With Toothpic, users simply answer a few questions and snap a photo of problem area. Within 24 hours, they’ll receive custom advice that includes options, costs and information on where they can find a Delta Dental dentist.

What’s next

The good news is that unemployment numbers are gradually dropping while COVID-19 vaccinations steadily rise. While this past year’s statistics may feel somber, they don’t have to be the final word. Affordable health care options like Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit for children, are more important than ever, as is education about the importance of dental health.

Policy pops: Medicaid expansion won many voters. Now what?

2‑minute read

Join our guest blogger, Devin McBrayer, as she explains how the results of the midterm election affect Medicaid expansion across the country. Devin is a Legislative and Policy Analyst based in Sacramento, California.

The 2018 midterm election revealed that many Americans support Medicaid expansion: Three of four states with expansion on the ballot voted to approve it, and two of four gubernatorial candidates supporting Medicaid expansion won election. If these states are successful in growing their programs, access to dental care for low-income Americans will likely increase. However, the futures of these states’ Medicaid programs face political and financial obstacles.

Utah, Nebraska and Idaho voters approved expanding coverage to 300,000 low-income Americans, yet these states are already experiencing pushback or challenges:

  • In Idaho, while the ballot initiative to expand Medicaid passed with more than 60% of voters, Republicans in the state have filed a lawsuit against the ballot initiative saying that it violates parts of the state’s constitution.
  • Implementation efforts in Utah are likely to be blocked by conservatives in the state House of Representatives.
  • The Nebraska state legislature faces the difficult task of figuring out how to pay for the program.

Meanwhile, Montana voted to allow their existing Medicaid expansion to sunset in 2019, which means Montanans who previously gained health care coverage will lose it on January 1, 2019.

Complicating matters, in all states the 100% federal funding match for newly eligible Medicaid enrollees has begun to phase down. By 2020 the match will drop down to 90%, which will force states to finance a greater share of expansion costs. 

Aside from ballot initiatives, four gubernatorial candidates ran with Medicaid expansion as a core part of their political platform. Two Democratic candidates supporting expansion won their races and flipped their state executive office, but the path to expansion isn’t clear.

  • In Wisconsin, Republicans in the state Assembly and Senate have already passed bills that could limit the powers of Governor-elect Tony Evers, including his Medicaid expansion efforts.
  • In the Kansas election that put Democrat Laura Kelly in the governor’s office, voters also elected a more conservative Legislature. Any bill seeking to expand Medicaid in Kansas will now have a tougher time getting to the governor’s desk.

The gubernatorial candidates supporting Medicaid expansion in Florida and Georgia lost their races, further lowering the possibility for expansion in these states.

Delta Dental will continue to monitor the impact of these elections and other trends that could have major impacts on low-income adults’ access to dental benefits and care across the country.

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If you’re a benefits decision maker, administrator or HR professional, subscribe to our group newsletter, Word of Mouth.

Policy pops: Midterm elections’ impact on Medicaid (and dental) expansion

3‑minute read

Join our guest blogger, Devin McBrayer, as she explores the role of Medicaid expansion in the midterm elections and the potential impact on low-income adults’ access to dental benefits. Devin is a legislative and policy analyst based in Sacramento, California.

Midterm elections are just around the corner on November 6, and the results of the election could change the future of Medicaid in several states. Medicaid expansion is an important platform issue for some contested governors’ races as well as the subject of several ballot initiatives across the country. If more states expand Medicaid coverage for adults through the Affordable Care Act (ACA), dental coverage for low-income adults could also grow.

Currently, 33 states, plus Washington D.C., have opted to expand Medicaid, and 14 states have chosen not to do so. Three states, Idaho, Nebraska and Utah, will vote on Medicaid expansion for the first time this Election Day. If these states vote to expand their Medicaid programs, an additional 300,000 low-income Americans would be eligible for coverage. Montana also has a ballot initiative to extend their temporary expansion that covers 100,000 people in the state. Unless Montana voters approve the ballot initiative, the temporary expansion of Medicaid will end in 2019.

Several hotly-contested races for governor also feature Medicaid expansion as a central issue for candidates. Florida, Georgia, Kansas and Wisconsin all have Democratic gubernatorial candidates interested in expanding Medicaid if elected. Medicaid expansion could open the doors to providing more extensive dental benefits for those states’ adult populations in the future. Florida and Georgia’s current state Medicaid programs, in particular, offer emergency-only adult dental benefits, which are most often limited to pain relief under very specific situations.

Most states offer a limited dental benefit to their adult Medicaid population, but since adult dental is not a required benefit and the state must pay the entire cost of providing the benefit, fewer than half of states offer an extensive adult dental benefit. In FY 2018, 19 Medicaid expansion states chose to enhance the covered benefits in their Medicaid program, and three of those states, Arizona, California and Utah, chose specifically to enhance the dental benefit or access to dental services.

Along with the impact of elections on Medicaid expansion, it’s important to have an eye on the economic conditions. States that expanded their Medicaid programs in 2014–2016 received a 100% funding match from the federal government for newly eligible Medicaid enrollees. However, this federal match has begun to phase down and by 2020 the match will drop to 90%, which will force states to finance a greater share of the costs of Medicaid expansion. Delta Dental will continue to monitor these important elections and other trends that could have big impacts on low-income adults’ access to dental benefits across the country.

For more thought leadership from Delta Dental, subscribe to Insider Update, our newsletter for brokers, agents and consultants.

If you’re a benefits decision maker, administrator or HR professional, subscribe to our group newsletter, Word of Mouth.

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