Responding to the surprising number of kids getting braces while covered by the Children's Health Insurance Program [CHIP], a Utah lawmaker is looking to pare the plan's dental benefits.
Health officials base CHIP dental benefits on the state's most widely sold private plan. They didn't realize it includes coverage for braces and other teeth-straightening treatments until they saw "an inordinate number" of orthodontia claims, said Rep. Jim Dunnigan, R-Taylorsville. "It's not that that's bad, but we have limited dollars."
Dunnigan proposes allowing "medically necessary" orthodontic care, but refusing cosmetic claims, which would bring the program in step with Medicaid. The provision is tucked into an omnibus health reform bill he's sponsoring, HB144, which contains myriad other changes.
It reauthorizes a legislative task force to guide implementation of federal health reform. Among the decisions the task force will face is how to insure Utahns who earn incomes just above Medicaid-eligible levels, those at 133 percent to 200 percent of the federal poverty level.
The group will also take part in designing the essential benefits package, the minimum set of benefits that virtually all Americans must have in 2014. In addition, the bill would give parents with kids on CHIP the option of switching to subsidized, private coverage for the whole family.
The omnibus measure passed the House and rests now with the Senate. If passed, the reduction in CHIP dental benefits wouldn't take effect until July 1.
Low-income advocates back the change, fearing that if too much money is spent straightening teeth, the state will cut corners elsewhere, possibly lowering payments to dentists for preventive care.
CHIP is a health safety net for children of working, low- and middle-income parents who don't have access to employer-based coverage. A family of four must have a household income of $44,700 or less. More than 370 CHIP enrollees received orthodontic care in 2011.
The Utah Department of Health doesn't have data showing how much was spent. But the plan has a lifetime limit on orthodontic care of $1,000, and braces alone can cost several thousand dollars, which means families either cut treatment short or came up with the rest of the money.
Orthodontic care has only been available for two years, and there may have been pent-up demand for the service, said a health spokeswoman Kolbi Young, who expects claims to drop off.