Biden Administration to Allow States to Include Adult Dental Services as an Essential Health Benefit

Last week HHS finalized a new rule allowing states to include adult dental services in the list of designated essential health benefits required to be covered by most health plans under the Affordable Care Act.

States that add adult dental to their benchmark plan would also guarantee coverage for people on the state’s Medicaid program.

When the ACA was passed in 2010, children’s oral health services were included in the statutory language within the ten categories of services that were required to be considered…  but adult oral health services were excluded. The new HHS rule removes that long-standing prohibition and allows states to include adult oral health services as a standard benefit.

If states take the option presented in this new rule and update their benchmark plans to include adult dental services, all qualified health plans will be required to incorporate adult dental services either within the medical plan or via a contract with a standalone dental plan issuer. States that wish to add dental coverage will have to go through the process of updating their benchmark plan to specify the inclusion of adult dental services as an essential health benefit.

Governor Hobbs’ executive order last week around Arizona’s essential health benefits around reproductive health didn’t mention anything about oral health…  but this new rule provides a fresh opportunity to advocate for adult oral health to be incorporated as a benchmark essential health benefit.

Note: Back in 2014, Governor Brewer picked the AZ State Employee ‘EPO’ Plan as the benchmark for Arizona’s Marketplace plans. Ever since then, Marketplace plans have needed to cover (at a minimum) the same benefits as the state employee plan. Other commercially available plans need to be “substantially equal” to the state employee benchmark plan in scope, limitations, and exclusions (e.g. visit limits).

At the time, I opined on my ADHS Blog that the choice was a good one because it had a robust behavioral health component with fewer limitations, restrictions and exclusions than most other options- and already covers behavioral health services at parity (meaning behavioral health has the same level of coverage as physical health). To my knowledge, the Ducey administration never made any changes to that benchmark plan.