Medicaid Should Cover Treatment for Handicapping Malocclusion in Children
A Smile for Kids
A Smile for Kids (ASK) provides equitable access to orthodontic care to improve the self confidence, health, and resilience of underserved youth throughout Oregon. We exist as a nonprofit organization because Oregon’s interpretation of CMS guidelines currently only allows orthodontic treatment when cleft palate or craniofacial anomalies are involved. This leaves out the vast majority of kids who are members of OHP. ASK reserves resources for the most serious cases of handicapping malocclusions and see daily how braces and oral surgery positively affect the trajectory of all Oregon’s youths who suffer from severe self esteem challenges and physical disorders such as trouble breathing, speaking, eating, and sleeping. Qualifying severe handicapping malocclusion causes loss of normal function and disfiguration. 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.
Our Ask
Oregon’s Medicaid program serves 1 in 5 Oregonian adults and 2 in 5 Oregonian children. Thus, it is a critical part of our state’s health care system. Today we urge Oregon’s Health Care Authority to move toward approving coverage for handicapping malocclusion for children enrolled in Medicaid.
Treatment for Dental Conditions is Required to be Covered for Children Enrolled in Medicaid
State Medicaid programs are required to cover treatment needed to correct or ameliorate medical conditions identified in enrolled children. This includes treatment of dental conditions, including care needed for relief of pain and infections, restoration of teeth, and maintenance of dental health. It also includes therapeutic services needed to address dental disease, including orthodontic treatment when medically necessary to correct handicapping malocclusion. Every state in the nation except Oregon currently covers treatment for handicapping malocclusion in children. It is time for Oregon to address this serious gap in its Medicaid coverage.
Oregon’s Disadvantaged Children Are Being Hurt by This Gap in Coverage.
Applicant living in extreme poverty, mother stage 4 renal failure, dad confined to a wheelchair, neither parents drive. Two children and elderly grandmother living in household with parents. A was withdrawn and extremely shy. Once braces were put on, she joined drama class. Before they were off she had graduated high school and was accepted into the American Academy of Fine Arts in New York with a full 4 year scholarship. Transformative results from orthodontic treatment.
Lived in a cabin with no plumbing or electricity after her mother passed away. Her father was not able to care for her. Extreme overbite where she could not close her lips. During orthodontic treatment, B gained confidence to excel in academics. She graduated with a full ride scholarship to OSU, and is studying to be a Neurologist. "Braces gave me a fresh start in life.
ASK does not have a waiting list as we pay orthodontists to treat OHP youths. This leads to a considerable amount of goodwill towards our program and allows us to place applicants with orthodontists in their local area without delay. ASK accepts roughly 60 new applicants every year and during non-COVID years we have an average of 200 youths active in braces at any given time. The state range of $5,000 to $7,500 cost of orthodontic treatment (without complications), and no assistance from Oregon’s Health Plan, deliberately creates and maintains massive barriers to health for historically low-income populations, exacerbating additional health problems. This runs counter to the triple aim of improving the individual experience of care, improving the health of populations; and reducing the per capita costs of care for populations.
Conclusion
ASK recommends that Medicaid should cover treatment for handicapping malocclusion in children in Oregon. Without equitable access to orthodontic care for Oregon’s Medicaid youth, old systemic barriers remain in place to actively decrease the physical, oral, mental and behavioral health for kids who need help the most. To assist in developing the coverage criteria and the reimbursement rubric for including handicapping malocclusion, we can provide orthodontic and dental experts from the large group of statewide orthodontists, oral surgeons and dentists that we work closely with on a daily basis.
Sincerely, Christian Moller-Andersen, Executive Director