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Child advocates push to plug hole in California's pediatric dental coverage

Dr. Sharine Thenard, left, of Alameda Pediatric Dentistry believes dental coverage for kids should be mandatory to ensure oral health.
Dr. Sharine Thenard, left, of Alameda Pediatric Dentistry believes dental coverage for kids should be mandatory to ensure oral health.
Julie Small/KPCC

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At Alameda Pediatric Dentistry, Dr. Sharine Thenard examines 8-year-old Duke Denny’s teeth. His mother, Maya, sits close by his side. During the exam, Dr. Thenard tells her that Duke has been grinding his teeth:  

“I’m just going to see if they’re wiggly or not,” she says.

Turns out Duke’s teeth are firm. 

Teeth grinding is just one of the childhood dental problems Thenard treats. She also  sees very young children who’ve developed “rampant decay.”

“A lot of times it’s sleeping with the bottle, nursing all night, never brushing the teeth," Thenard says. "Juice in the bottle, I’ve seen soda in the bottle, Gatorade in the bottle — really terrible stuff.”

The California Society of Pediatric Dentistry reports that tooth decay is the most prevalent childhood disease. More children miss school because of dental pain than any other reason. That’s why pediatric dental care is considered an essential health benefit in the Affordable Care Act — the federal law that requires every American to have health insurance.

But state-run health care exchanges can offer medical insurance without pediatric dental care as long as they sell stand-alone plans. The federal law made that exemption because nearly all people who have dental insurance today have stand-alone plans.  This way they’ll be able to keep their same dentists even after federal reforms take effect.

That explains why the state’s new health care exchange, Covered California, chose to offer stand-alone dental plans for children. But it doesn’t explain why the Covered California staff decided to tell insurance companies to strip pediatric dental care from their coverage offered through the exchange, which opens to consumers in October.

Betsy Imholz is with Consumers Union, the policy division of Consumer Reports. She says Covered California's action was a mistake that's probably too late to undo for the first year of the program. 

“Hopefully it won’t be a big black eye,”  she says.

Taking children's dental care out of general health care plans will push up the cost for as many as a quarter of a million children who are expected to get insurance through the exchange. Imholz says their families will have to pay anywhere from $10-to-$30 extra a month for dental care for each of their kids.

“If you’re really watching your budget, and just barely making rent and food, health insurance could be tough to pay for,” Imholz says.  “So an extra $10-to-$30 a month, per child, could be a lot.” 

Families that purchase stand-alone dental care will also have to pay a separate deductible, and fulfill a separate out-of-pocket maximum. Covered California spokesman Dana Howard says that’s not necessarily a bad thing.

“It depends on how you look at it,” Howard says  “You can slice it and dice it in whole different ways depending on each individual’s particular scenario.” 

Howard says a stand-alone dental plan enables parents to hit a $1,000 out-of-pocket maximum sooner than if the coverage was included in a comprehensive health plan, where that maximum is more than $12,000 for a family.

“You could easily reach your maximum out-of-pocket maximum of a thousand dollars or so for your dental coverage, and then you’re done,” Howard says.

Pediatric dentist Thenard says she’s not so worried about the exchange’s choice to offer stand-alone plans. To her — and to many child health care advocates — the big problem is that parents who purchase medical insurance through the exchange could opt out of dental care for their kids. 

“If you don’t mandate the families to buy it, then it’s the first thing that gets chopped off their list, because they think it’s just a disposable kind of thing," Thenard says. "They think, ‘I’m just going to save a few bucks and I’m not going to get the dental portion of it.’”

The board of California Covered holds a special meeting Thursday to talk about what kind of children’s dental coverage to sell to the public beginning October 1.

Board members could decide to make pediatric dental coverage mandatory for parents who buy on the exchange. That could be for the first year or the board members could hold off until they have a better sense of the costs of health care expansion.