Pierce County community and oral health coalition members, representing 28 agencies and provider offices, gathered at PCOHC’s Feb. 12 meeting to learn more about health care reform’s impact on oral health benefits. (Two CE credits were offered.)

Presentations were made by representatives from the Washington State Health Care Authority (HCA) and the state’s insurance marketplace known as the Washington Health Benefit Exchange (HBE).

Adult Dental Benefits (Medicaid)

Dianne Baum, dental program manager at the HCA, provided a comprehensive summary of the Washington Apple Health (Medicaid) Adult Dental benefits that the state legislature restored, and in some cases enhanced, effective Jan. 1, 2014.

Baum’s presentation addressed the following topics:

• Eligibility parameters
• Covered dental services, limitations and exclusions
• Answers to commonly asked questions and resources for additional Medicaid dental information
• Current and prospective Medicaid provider support: Baum emphasized the availability of the HCA’s Medicaid dental experts to provide one-on-one assistance to prospective providers as well as support those providers who currently serve Medicaid-covered patients.
• Claim Review and Pre-authorization: HCA’s dental staff consists of professional, licensed dental practitioners and benefit professionals who assist with and oversee Medicaid claim documentation, review and authorization of dental treatment plans.

The Washington State HCA Medicaid Provider Guide for Dental-Related Services effective January 1, 2014, may be found here.

Pediatric Dental Benefits

Christine Gibert, senior policy analyst for Washington’s insurance marketplace, the HBE, outlined the history and current status of the new pediatric dental benefit offered through the HBE.

Gibert’s presentation touched on the following topics:

• The mandatory purchase of pediatric dental benefits for any eligible child for whom a medical plan is purchased on the HBE,
• Dental plan premiums, and
• Coverage limits and deductibles that remain separate and distinct from medical plans.

Gibert said the HBE Board recognized the current dental-purchasing experience remained challenging for HBE consumers and providers alike.

While Washington’s lawmakers were currently considering legislation to allow embedding  pediatric dental benefits into medical plans, she said that 2016 was realistically the earliest implementation date for other changes to the HBE’s pediatric dental benefit.

Gibert said the HBE’s Dental Technical Advisory Committee (DTAC) provided an avenue for community input and information.

Ed. Note: The PCOHC thanks Baum and Gibert for their presentations, as well as Evergreen State College-Tacoma Campus for the use of its facility.