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Expanded Orthodontic coverage on the Table for Oregon Health Plan

Updated: Oct 29, 2021


Oregon’s Medicaid program might expand its limited orthodontic coverage to include

treatment for severe, or "handicapping," cases of poorly positioned teeth in children. The Health Evidence Review Commission's Oral Health Advisory Panel will review the change during its virtual meeting on Wednesday. HERC, as it's called, reviews clinical evidence to determine which benefits the Medicaid should include in its Prioritized List of Health Services. A HERC subcommittee will consider the new coverage at its

November meeting. The Bend-based nonprofit A Smile for Kids is urging HERC to

approve “handicapping malocclusion” in youth as a covered benefit, as every state except Oregon covers this treatment. “It is time for Oregon to address this serious gap in its Medicaid coverage,” Christian Moller-Andersen, A Smile for Kids’ executive director, said in a comment letter on the proposed policy change.

Malocclusions encompass crowding of teeth, overbite and cross- bite brought on by premature tooth loss, thumb sucking or pacifier use. In extreme cases, the condition can be considered handicapping and children can have difficulty biting, chewing,

swallowing and speaking.

Currently, the Oregon Health Plan only covers orthodontic treatment for cleft palate or craniofacial anomalies, leaving out the “vast majority of kids who are members of OHP,” Moller-Andersen said. Two in five Oregon children are covered by OHP. "We recognize (severe malocclusions) can have a physical and emotional impact, and we take that seriously and want to look at what can be done to address it," said Dr. Kaz Rafia, dental director for the Oregon Health Authority. He said it's hard to gauge how many patients would benefit and what the cost would be.

A Smile for Kids helps the most serious malocclusion cases and sees how braces and oral surgery benefit Oregon kids who suffer from “severe self-esteem challenges and physical disorders such as trouble breathing, speaking, eating and sleeping,” Moller-Andersen said. The nonprofit accepts about 60 new applicants a year and had an average of 200 youths in braces at any given time before the Covid-19 pandemic. Treatment costs range from about $5,000 to $7,500.

Severe malocclusion causes “loss of normal function and disfiguration,” Moller-Andersen said. “Without treatment, mental health is negatively affected, long-term health consequences are costly to the health care system and educational and job

opportunities are lost, which is costly to communities.”

Elizabeth Hayes

Staff Reporter

Portland Business Journal

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