The California Health Benefits Exchange Board, the governing body for Covered California, met Thursday, August 8 in Sacramento for a special half day morning session. Unlike previous board meetings, today’s agenda was very short. Agenda items included the Executive Director’s Report, which is customary and “Dental Policy Issues” which encompassed a discussion on pediatric dental coverage.
The presentation on pediatric dental coverage begin with the reading of a written message from Dr. Ross (Dr. Ross was not present at today’s Board Meeting) acknowledging the complexity involved in providing pediatric dental as an embedded benefit in the near term, but also wanting the Board to send a signal of the importance of preventative oral health for children as we find a solution for the future.
Executive Director, Peter Lee went on to acknowledge that the process for dealing with pediatric dental has been “less than ideal” in terms of engaging consumers, but he, on behalf of the board, committed to doing a better job moving forward.
The presentation provided a comprehensive update from the Board’s perspective on the following: What’s at stake? Where we are? What we’ve done? Who we’ve engaged? Where we’re going?
The issue is that while the ACA includes pediatric dental as one of the 10 essential benefits all plans must have, this has not traditionally been offered embedded in individual market plans, but rather as stand alone supplemental policies.
A few highlights from the presentation: There are a total of 2,600,000 Covered California pediatric dental subsidy-eligible Californians and 1,980,000 Covered California pediatric dental non-subsidy eligible Californians.
Informal requests for information to bidders for pediatric dental were made to all plans. 13 plans were contacted and of the plans that responded, a majority expressed that they were willing to develop an embedded product. 2 out of the 10 plans that responded expressed that they were unwilling to develop an embedded product. Of the plans that responded, 6 plans expressed that they would have the ability to develop an embedded product no earlier than 2015. 2 plans expressed that they might have the ability to develop an embedded product in 2014 or before 2015–but not if they were competing against plans that did not have this benefit embedded. Based on these results and the short amount of time until the launch in October, Covered California staff concluded there was “no silver bullet” for resolving the issue in 2014, and recommended that the board continue with offering the stand-alone plans for year one. But they recognized there was a need to change for 2015.
The presentation continued with a discussion about some of the challenges that exist in developing a health plan product that included pediatric dental as an embedded product. On the question of whether the purchase of pediatric dental should be mandatory, the staff recommendation was that it be encouraged, but not required. Finally, the presentation concluded with a commitment from the Board to go back to the drawing board and do a policy analysis on the question of “What is the “best” public policy for California’s children?”, “What should Californians be mandated to purchase?”, and “Who should pay?” Answers to these questions will ultimately inform the type of product that is designed (Is it best to embed the benefit or bundle? Should there be a single shared medical and dental OOPM? How will cost sharing work? How will products be billed?). Finally, based on the policy decisions, a “portfolio” that provides embedded, bundled or a stand-alone coverage will be established. The portfolio that is designed may also offer more than one option to consumers based on the outcome of the policy analysis.
The following factors will be taken into consideration by the Board in developing pediatric dental coverage for 2015 and on: Affordability, consumer protection/service, alignment of Covered California’s marketplace and the broader market, meeting federal and state requirements, and operational feasibility.
Health Access and other advocates, including Children Now, CPEHN, Western Center on Law and Poverty, Consumers Union and the Children Defense Fund weighed in with their support of the inclusion of pediatric dental as an embedded benefit, expressing a similar sentiment that doing otherwise treats pediatric dental as a supplemental benefit and not an essential health benefit as recognized by the Federal government. Groups like Anthem Blue Cross, the California Dental Association and the California Association of Dental Plans supported moving in that direction but also expressed their appreciation of the Board’s decision to not move forward with the inclusion of pediatric dental as an embedded benefit prior to 2015.
The staff recommendation was that Covered California do a full review of 2015 options, with consideration given to the option of only offering embedded plans along with stand-alone dental plans in 2015 to the extent allowable by federal rules. Staff also recommended that Covered California give consideration to the federal requirement to offer 9.5 QHPs, and how to do so as part of a portfolio with embedded plans. The Board moved to support this staff recommendation.
Other notes of interest:
The Executive Director provided an update on upcoming town hall meetings through August. Town halls provide an opportunity for stakeholders to give feedback and ask questions, provide an update on Covered California’s progress, current plans and outreach and community education strategies and lastly, what you can do to help ensure every Californian has access to affordable health insurance. Town halls will be held in San Francisco, Oakland, Cerritos, Bakersfield, Hanford and Sacramento throughout the month of August. Seating is limited and prior registration is recommended. To register, please call 1-888-975-1141.
The next Exchange board meeting is August 22, 2013, in Sacramento.
Health Access California promotes quality, affordable health care for all Californians.