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Maternal and Child Health Journal

Erschienen in:

02.12.2017

Oral Health Coverage Options for Pregnant Adults and Adolescents

verfasst von: Hindi E. Stohl, Amy Chen

Erschienen in: Maternal and Child Health Journal | Ausgabe 1/2018

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Abstract

Oral health care is a necessary and critical component of health care for pregnant women, but its importance is often overlooked by clinicians. Pregnant women who are low-income also find it particularly difficult to access care. This analytic essay summarizes oral health coverage for pregnant women under various types of health insurance coverage, including Medicaid, the Children’s Health Insurance Program, and coverage options available under the Affordable Care Act. We hope this information will help clinicians better understand the importance of oral health care during pregnancy and the range of coverage options that may be available to their patients.

See Committee on Health Care for Underserved Women, Am. Coll. of Obstet. Gynecol. (ACOG), Oral Health Care During Pregnancy and Through the Lifespan (2013).

Id. at 3; Gaffield et al. (2001).

Id.; See Azofeifa et al. (2014).

Kaiser Family Found., Medicaid’s Role for Women Across the Lifespan: Current Issues and the Impact of the Affordable Care Act. (2012).

42 U.S.C. §§ 1396d(a)(4)(B); 1396d(a)(5)(B), 1396a(a)(10)(A).

42 U.S.C. §§ 1397 cc(c)(5) (CHIP), 18022(b)(1)(J) (ACA).

Sanz et al. (2013); Boggess (2008).

Lieff, supra note 1 at 122; Silk supra note 12 at 1140.

Ide and Papapanou supra note 1 at S190–S191.

ACOG, supra note 4 at 2. See also Boggess supra note 12 at S172.

Suri et al. (2014); George et al. (2012).

Boggess and Edelstein (2006).

ACOG, supra note 4 at 2; Silk et al. (2008).

ACOG, supra note 4 at 3; Am. Acad. of Pediatric Dentistry, Guideline on Oral Health Care for the Pregnant Adolescent, 31 Clinical Guidelines 108, 111 (2007); American Academy of Periodontology statement regarding periodontal management of the pregnant patient. Journal of Periodontology 2004; 75(3):495.

ACOG, supra note 4 at 3.

ACOG, supra note 4 at 3; Nat’l Maternal and Child Oral Health Resource Center, Oral Health Care During Pregnancy: A Nat’l Consensus Statement 1, 2 (2012), http://www.mchoralhealth.org/PDFs/OralHealthPregnancyConsensus.pdf.

Am. Acad. of Pediatric Dentistry, supra note 18 at 111.

Boggess, supra note 10 at 977. See California Dental Association, Oral Health During Pregnancy and Early Childhood (2010).

42 C.F.R. § 440.210(a)(2).

42 C.F.R. § 435.116(d)(3). See also 77 Fed. Reg. 17,144, 17148-49 (March 23, 2012); 78 Fed. Reg. 42160, 42281 (July 15, 2013).

42 C.F.R. § 435.116(d)(3). See also 77 Fed. Reg. 17144, 17148-49 (March 23, 2012); 78 Fed. Reg. 42160, 42281 (July 15, 2013).

Medicaid and CHIP Payment and Access Commission. “Report to Congress: Coverage of Medicaid Dental Benefits for Adults.” 29 Table 2. 2 June 2015. https://www.macpac.gov/wp-content/uploads/2015/06/Medicaid-Coverage-of-Dental-Benefits-for-Adults.pdf. Accessed September 14, 2015.

42 USC 1396a(a)(10), text following subsection (G) at (V); 42 C.F.R. § 440.250(p).

Centers for Health Care Strategies, Inc. “Medicaid Adult Benefits: An Overview.” October 2015. http://www.chcs.org/media/Adult-Oral-Health-Fact-Sheet_101915.pdf. Accessed October 25, 2015.

Kaiser Family Foundation. “Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016.” October 15, 2015. http://kff.org/medicaid/report/medicaid-reforms-to-expand-coverage-control-costs-and-improve-care-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2015-and-2016. See also Medicaid and CHIP Payment and Access Commission. “Report to Congress: Coverage of Medicaid Dental Benefits for Adults.” APPENDIX 2A: State Dental Benefits Policies, as of February 2015. June 2015. https://www.macpac.gov/wp-content/uploads/2015/06/Medicaid-Coverage-of-Dental-Benefits-for-Adults.pdf. Accessed September 14, 2015.

Medicaid and CHIP Payment and Access Commission. “Report to Congress: Coverage of Medicaid Dental Benefits for Adults.” 27–28. June 2015. https://www.macpac.gov/wp-content/uploads/2015/06/Medicaid-Coverage-of-Dental-Benefits-for-Adults.pdf. Accessed September 14, 2015.

Committee on Oral Health Access to Services, Inst. of Med., Improving Access to Oral Health care for Vulnerable and Underserved Populations 241. 2011. http://books.nap.edu/openbook.php?record_id=13116. Accessed September 14, 2015.

42 U.S.C. § 1396a(a)(43). See also CMS, State Medicaid Manual § 5010.

42 U.S.C § 1396d(r)(3).

Id.

42 U.S.C. § 1396d(r)(5); §§ 42 C.F.R. § 440.40(b)(2), 441.50, 441.57. See also CMS, “Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children & Adolescents” September 2013, https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Downloads/Keep-Kids-Smiling.pdf; CMS, “EPSDT: A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents” (June 2014), https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Downloads/EPSDT_Coverage_Guide.pdf.

42 U.S.C. § 1397aa(a).

42 C.F.R. § 457.10.

42 U.S.C.A. § 1397bb.

Kaiser Family Found., Status of State Action on the Medicaid Expansion Decision. 26 Table 1. January 12, 2016. http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act. Accessed February 10, 2016.

42 U.S.C. § 1397 cc(c)(5)(A). See also Dear State Health Official (October 7, 2009).

42 U.S.C. § 1397 cc(c)(5); Dear State Health Official (October 7, 2009).

Dear State Health Official (October 7, 2009).

42 U.S.C. § 1397jj(b)(5).

Dear State Health Official (October 7, 2009).

Id.

National Academy for State Health Policy. “Coverage of Pregnancy Services in the Children’s Health Insurance Program (CHIP). June 2014. https://www.statereforum.org/system/files/overview_of_available_chip_coverage_authorities_for_covering_pregnancy_services.pdf. Accessed September 15, 2015.

U.S. Department of Health and Human Services. Dear State Health Official Letter. July 31, 2000.

42 U.S.C. § 1397kk(b)(1)(A); 42 U.S.C. § 1397kk(b)(2)(A).

Evelyn P. Baumrucker and Alison Mitchell. “State Children’s Health Insurance Program: An Overview” 11. Congressional Research Service. March 20, 2015. Available at https://www.fas.org/sgp/crs/misc/R43627.pdf. Accessed September 15, 2015. See also National Academy for State Health Policy. “Coverage of Pregnancy Services in CHIP, 2013.” July 9, 2014. Available at https://www.statereforum.org/coverage-of-pregnancy-services-in-chip. Accessed September 15, 2015.

42 C.F.R. § 457.10.

Evelyn P. Baumrucker and Alison Mitchell. “State Children’s Health Insurance Program: An Overview” 11–12. Congressional Research Service. March 20, 2015. https://www.fas.org/sgp/crs/misc/R43627.pdf. Accessed September 15, 2015. See also Kaiser Family Foundation. “Medicaid and CHIP Eligibility Limits for Pregnant Women as a Percent of the Federal Poverty Level” January 1, 2015. http://kff.org/health-reform/state-indicator/medicaid-and-chip-income-eligibility-limits-for-pregnant-women-as-a-percent-of-the-federal-poverty-level. Accessed October 25, 2015.

March of Dimes. CHIP Coverage for Pregnant Women. October 30, 2013. Available at http://www.marchofdimes.org/materials/chip-coverage-for-pregnant-women-may-2014.pdf. Accessed September 15, 2015.

42 U.S.C. § 1397 cc(a). See also Dear State Health Official #09-010 (September 3, 2009).

Blue Cross and Blue Shield, 2015 Blue Cross and Blue Shield Service Benefit Plan § 5(g). https://media.fepblue.org/-/media/PDFs/Brochures/2015_SBP_BRO_FINAL_145_102714.pdf. Accessed September 15, 2015.

See Dear State Official Letter (May 11, 2009).

March of Dimes. CHIP Coverage for Pregnant Women. October 30, 2013. http://www.marchofdimes.org/materials/chip-coverage-for-pregnant-women-may-2014.pdf. Accessed September 15, 2015.

42 U.S.C. § 1396b(v)(4)(A). See also Dear State Health Official (July 1, 2010).

Kaiser Family Foundation. Medicaid/CHIP Coverage of Lawfully-Residing Immigrant Children and Pregnant Women. January 1, 2015. http://kff.org/health-reform/state-indicator/medicaid-chip-coverage-of-lawfully-residing-immigrant-children-and-pregnant-women. Accessed September 15, 2015.

Id.

42 U.S.C. § 1396a(a)(10)(A)(i)(VIII).

The Supreme Court effectively made this coverage optional for the states in National Federation of Independent Business v. Sebelius,132 S.Ct 2566.

See Kaiser Family Found., Status of State Action on the Medicaid Expansion Decision. January 12, 2016. http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act. Accessed January 13, 2016.

42 U.S.C. § 1396a(a)(10)(A)(i)(VIII).

Medicaid Program; Eligibility Changes Under the Affordable Care Act of 2010; Final Rule. 77 Fed. Reg. 17144, 17149 (March 23, 2012).

42 U.S.C. § 1396u-7(b)(5).

42 U.S.C. § 18022(b)(1)(J).

These coverage options are: (1) standard Blue Cross/Blue Shield PPO under the Federal Employees Health Benefits Program; (2) any generally available state employee plan in the state; (3) the HMO plan with the largest commercial non-Medicaid enrollment in the state; (4) Secretary-approved coverage; or (5) Benchmark equivalent plan.

See generally, Michelle Lilienfeld, National Health Law Program, “Health Advocate: Alternative Benefit Plans” (August 18, 2014), http://www.healthlaw.org/publications/search-publications/Health-Advocate-August-2014.

42 U.S.C. § 1396u-7.

42 C.F.R. § 440.315.

26 U.S.C. § 36B.

Marketplace plans are available in four different metal categories: Bronze, Silver, Gold, and Platinum. The metal plans vary based on how the cost of care is split as between the plan and the enrollee. Plans in the Bronze category have the lowest monthly premiums, but the highest deductibles and other out-of-pocket costs. On the flip side, plans in the Platinum category have the highest monthly premiums, but the lowest deductibles and other out-of-pocket costs. Enrollees who qualify for cost sharing reductions will have the benefit of a relatively low premium and a lower deductible and other out-of-pocket costs owing to the cost sharing reductions.

42 U.S.C. § 18071.

Kaiser Family Foundation. State Health Insurance Marketplace Types, 2015. http://kff.org/health-reform/state-indicator/state-health-insurance-marketplace-types. Accessed September 16, 2015.

42 U.S.C. § 18022(b)(1)(J).

45 C.F.R § 156.115(d).

42 U.S.C. § 18022(b)(1)(D).

42 U.S.C. § 18031(d)(2)(B)(ii).

Azofeifa, A., et al. (2014). Oral health conditions and dental visits among pregnant and nonpregnant women of childbearing age in the United States, National Health and Nutrition Examination Survey, 1999–2004. Preventing Chronic Disease, 11, 9.CrossRef

Boggess, K. A. (2008). Maternal oral health in pregnancy. Obstetrics & Gynecology, 111, 976–983.CrossRef

Boggess, K. A., & Edelstein, B. L. (2006). Oral health in women during preconception and pregnancy: Implications for birth outcomes and infant oral health. Maternal Child Health Journal, 10, S169–S172.CrossRef

Gaffield, M. L., et al. (2001). Oral health during pregnancy: An analysis of information collected by the pregnancy risk assessment monitoring system. The Journal of the American Dental Association, 132, 1009–1015.CrossRefPubMed

George, A., et al. (2012). How do dental and prenatal care practitioners perceive dental care during pregnancy? Current evidence and implications. Birth, 39, 238–247.CrossRefPubMed

Sanz, M., et al. (2013). Periodontitis and adverse pregnancy outcomes: Consensus report of the Joint EFP/AAP workshop on periodontitis and systemic diseases. Journal of Clinical Periodontology, 84(4 Supp), S164–S168.

Silk, H., et al. (2008). Oral health during pregnancy. American Family Physician, 77, 1139–1140.PubMed

Suri, V., et al. (2014). A study of obstetricians’ knowledge, attitudes and practices in oral health and pregnancy. Education for Health, 27, 51–54.CrossRefPubMed

Titel: Oral Health Coverage Options for Pregnant Adults and Adolescents
verfasst von: Hindi E. Stohl
Amy Chen
Publikationsdatum: 02.12.2017
Verlag: Springer US
Erschienen in: Maternal and Child Health Journal / Ausgabe 1/2018
Print ISSN: 1092-7875
Elektronische ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-017-2401-1

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Oral Health Coverage Options for Pregnant Adults and Adolescents

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Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

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