Tooth decay in children advances at a far greater speed than in adults. The enamel in primary teeth (baby teeth) is much thinner, and results in teeth being more prone to advancing decay in a shorter period of time.
Early treatment of tooth decay in children is paramount in reducing the need for more costly or more invasive care down the road. Yet in many private dental insurance plans, there is a wait period of up to 12 months after enrollment before insurers will pay for the treatment of tooth decay in children. No state in the nation has attempted to address this misappropriation of care, until now. A bill submitted by state Sen. Heather Sanborn, L.R. 2910, An Act to Facilitate Dental Treatment for Children, will eliminate waiting periods for children to get dental treatment in Maine.
Since the release of the first Surgeon General’s Report on Oral Health in 2001, there has been mounting interest to improve the oral health of children in the United States. The Affordable Care Act included a provision for a pediatric oral health benefit that was intended to expand the availability of private dental benefits to children. As well, there have been many workforce initiatives proposed that are intent on improving the oral health of children.
Policy initiatives such as training more dentists, more pediatric dentists, more dental hygienists, expanding the scope of practice for hygienists and new dental providers to treat dental disease have all been initiated. Earlier prevention and new preventive tools have also been incorporated into practice to reduce disease risk. However, little has been accomplished with improving standalone private dental insurance, and no effort has been made to revamp dental benefits and wait periods for treatment.
Dental insurers argue that they must impose waiting periods for newly enrolled recipients of dental benefits to avoid costs to their plans when individuals enroll for insurance only after they realize they have dental issues. But this adverse selection issue doesn’t really apply when it comes to tooth decay in children. Children often face these waiting periods because a parent has changed jobs or parents enroll them for their first dental appointment. Many children see the dentist for the first time when they are newly insured, and many have dental disease identified at this first visit. Given what we know about the rapid progression of tooth decay in children and the importance of early intervention, insurance companies should not be able to delay those interventions by refusing to pay for them.
MaineCare, the state Medicaid program, has always provided immediate coverage for dental treatment for eligible children. Immediate access to necessary care can help avoid the painful consequences of tooth decay, as well as hospitalization. Yet private insurers have required waiting periods for treatment for decades. The insurers perhaps assume that if the dental issue is bad enough during the wait period, the parents simply can pay out of pocket for it, while also paying monthly premiums for coverage they can’t yet use. This puts timely dental care out of reach for many children, particularly those whose families earn just a little more than the threshold for MaineCare eligibility. This leaves those children in pain and risks future complications.
Children with dental insurance should have access to the urgent treatments they need, when they need them. Insurers should no longer be allowed to stand in the way of that access. The Legislature should support L.R. 2910, and ensure access to more timely dental treatment for Maine children, leading the way for the rest of the nation.
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