Investigating the Effects of Mandating Pediatric Oral Health Services as Essential Health Benefits

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Project Summary/Abstract Recent national health reforms, including the Affordable Care Act (ACA), have devoted relatively little attention to oral health despite the importance of oral health to overall health, particularly for children. A key factor in improving oral health is expanding access to preventive dental care. Despite the limited attention overall, there are several aspects of recent reforms that may affect oral health among children. Pediatric dental benefits are treated as an essential health benefit (EHB) for private insurance plans for children 18 and under. To meet this essential dental benefit objective states require that plans sold via private marketplaces either cover oral care as part of medical coverage or that stand-alone dental plans with appropriate coverage be offered. There is no requirement that the parent actually purchases the coverage, however, in the case of stand-alone dental plans, making the evaluation of the mandate important from a policy perspective. Additionally, both Medicaid and private marketplace insurance plans are required to provide a list of preventive services at no cost to patients. For children 10 years of age and younger, oral health risk assessments are included in the list of required preventive services. In terms of dental services, many states also go beyond these minimums and include additional oral health services as part of qualified health plans (QHP). These oral health provisions of recent national health reforms offer a unique opportunity to evaluate the effects of national and state coverage mandates on take-up of dental coverage and use of preventive dental services among US children nationally. The proposed study will identify the effects of oral health mandates for children under age 18 on dental coverage and use of key preventive services. This study is highly innovative as it takes advantage of a national policy potentially affecting millions of children. We can learn how effective mandates are in the context of child dental coverage and use of dental services. Evidence from this study will contribute meaningful knowledge about potential future policies tied to improving oral health among children and potentially among the broader adult population. We plan to evaluate multiple preventive dental measures and dental treatments in addition to assessing the effect on dental insurance coverage. We will further evaluate potential heterogeneity by race/ethnicity, income levels, parental education, and rural/urban status. We will use a nationally representative dataset to accomplish the proposed Specific Aims.