H.B. NO.














relating to pediatric dental health coverage.





     SECTION 1.  The Legislature finds that failure to prevent dental problems has long-term adverse effects that are consequential and costly to families and the health care system.  A review by the Children's Dental Health Project reports that the progressive nature of dental diseases, coupled with lack of access to preventive care, can significantly diminish the general health and quality for affected children.  Failure to prevent dental problems has long-term adverse effects that are consequential and costly.  Without access to regular preventive dental services, dental care for many children is postponed until symptoms, such as toothache and facial abscess, become so acute that care is sought in hospital emergency departments, driving up health care costs.

     A three-year aggregate comparison of Medicaid reimbursement for inpatient emergency department treatment ($6,498) versus preventive treatment ($660) revealed that on average, the cost to manage symptoms related to dental caries on an inpatient basis is approximately ten times more than to provide dental care for these same patients in a dental office.

     Statistics from Healthy Smiles Hawaii, a local dental health program, indicate that the rate of tooth decay among children living in Hawaii is two times as high as that among children on the mainland.  Early childhood cavities are the number one chronic disease affecting young children.  Less than 19 percent of local six-year-olds bear cavity-free permanent teeth, compared to more than 94 percent of their mainland counterparts.

     Healthy Smiles Hawaii also reported that medical insurance is a strong predictor of access to dental care.  Uninsured children are 2.5 times less likely than insured children to receive dental care.  Children from families without dental insurance are three times more likely to have dental needs than children with either public or private insurance.  For each child without medical insurance, there are at least 2.6 children without dental insurance.

     The Affordable Care Act (ACA) acknowledges the importance of pediatric dental healthcare.  Pediatric dental benefits are included amongst the ten categories of Essential Health Benefits which must be offered both inside and outside of the exchange market.

     While the ACA mandates these pediatric dental services to be offered in a qualified health plan, new federal guidance suggests there is no mandate for consumers to purchase them in Hawaii's Health Connector.  Federal regulations further clarify that, if a stand-alone dental plan is offered in an exchange, qualified health plans may still be considered qualified even if pediatric dental benefits are not embedded in the medical plan.

     This stands in contrast to the market outside of the exchange, where pediatric dental benefits will be required to be embedded in the base medical plan, establishing a mandate to both offer and for consumers to purchase pediatric dental benefits.  The inequity of plan offerings inside and outside of the exchange may produce a circumstance where only those in need of pediatric dental services will purchase them inside the exchange.  The consequence will be adverse selection that drives up the overall cost of providing this care for all children.

     Given this inequity, the Legislature believes requiring pediatric dental benefits to be included in the base medical plans both inside and outside of the exchange will ensure that the majority of Hawaii's children will enjoy dental health benefits.  Furthermore, with more people purchasing these plans, risk will be spread across a larger population, minimizing the opportunity for adverse selection.

     The purpose of this measure is to ensure pediatric dental benefits are included in all medical plans sold in Hawaii's Connector.  This will ensure dental health coverage for our children and go far in reducing other long-term health problems for our keiki.

     SECTION 2.  Section 435H-1, Hawaii Revised Statutes, is amended by amending the definition of "qualified plan" to read as follows:

     ""Qualified plan" means a health benefit plan offered by an insurer that meets the criteria for certification described in section 1311(c) of the Federal Act[.], and includes pediatric dental benefits as provided under the Federal Act."

     SECTION 3.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 4.  This Act shall take effect upon its approval.










Report Title:

Keiki Dental Health Coverage



Amends definition of "qualified patient" to include pediatric dental benefits as provided under the federal Affordable Care Act.




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