Legislative Efforts to Expand Dental Coverage and Access
Published by the American Dental Coders Association
Introduction
Access to dental care is gaining ground as a priority in health policy, as lawmakers work to address disparities in coverage and affordability. With growing recognition of oral health as integral to overall wellness, new legislative proposals are shaping the future of dental billing, reimbursement, and workforce expansion.
Expanding Dental Benefits in Medicare
Congressional leaders have introduced new bills aiming to integrate dental care into traditional Medicare. These initiatives propose adding dental benefits under Medicare Part B and are designed to reduce out-of-pocket costs, particularly for older adults. Recent regulatory reforms have also extended medically necessary dental coverage under Medicare for patients undergoing dialysis or organ transplants. These changes mark a significant shift toward recognizing the connection between oral and systemic health.
Breaking Down Barriers in Medicaid and Marketplace Plans
Several states have expanded adult dental benefits in Medicaid, offering comprehensive services beyond emergency care. Despite this progress, coverage remains inconsistent across states, prompting new efforts to standardize dental care as an Essential Health Benefit (EHB) under the Affordable Care Act. This change could allow states to include dental benefits in Marketplace plans, ensuring broader access with stronger consumer protections.
State-Level Solutions for Dental Access
States like New York and Wisconsin are leading the way with innovative legislative strategies. These include expanding the scope of practice for dental hygienists and therapists, investing in telehealth services for fluoride application, and increasing provider reimbursement in underserved areas. These policies aim to address dentist shortages and improve access to care in rural and low-income communities.
Advocacy Driving Change
Industry organizations and coalitions continue to push for reforms that make dental insurance more accessible. Proposals include allowing consumers to purchase stand-alone dental plans through federal exchanges and enhancing the visibility of dental plans on Healthcare.gov. Such efforts can increase enrollment, particularly among seniors and small-business employees.
Why These Changes Matter
Oral health is closely linked to conditions like diabetes, cardiovascular disease, and pregnancy complications. Inadequate access to dental care often leads to emergency room visits, missed workdays, and higher healthcare costs. Expanding dental coverage not only improves health outcomes but also supports a stronger, more inclusive healthcare system.
Looking Ahead
As legislation and regulations evolve, dental billing and coding professionals must be prepared. Expanded coverage will impact reimbursement models, coding requirements, and documentation standards. Staying informed will ensure that dental offices remain compliant and financially sound while helping more patients receive the care they need.
Join the ADCA
Stay ahead of healthcare changes with membership in the American Dental Coders Association. Access cutting-edge training, certification programs like the Certified Dental Billing Specialist (CDBS) and Certified Dental Coder (CDC), and free support via Ask-The-Coder.
