The Organized Dentistry Coalition, led by the American Dental Association, has urged CMS not to prohibit adult dental coverage from being an essential health benefit, according to a March 24 news release from the ADA.
Here are seven things to know:
- The 2027 Notice of Benefit and Payment Parameters proposed rule under the Affordable Care Act would effectively reverse a change from the 2025 Payment Notice that lifted a prohibition that prevented states from including routine adult dental services in benefit-benchmark plans.
- The coalition has asked CMS to finalize the policy outlined in the 2025 Payment Notice that would allow states to include routine adult dental services in their EHB-benchmark plan starting in plan year 2027.
- The previous change permitted states to add dental services starting in plan year 2027. The proposed rule would delay states’ ability to add the services until plan year 2029.
- More states are offering adult dental benefits in Medicaid programs, which the ADA says backs up the feasibility of broader inclusion.
- The coalition argued that excluding dental services would increase fragmentation in dental coverage.
- The group is also opposing a proposal to reduce the required percentage of essential community providers in Qualified Health Plans and stand-alone dental plans from 35% to 20%, saying that lowering the threshold could reduce access to care.
- In addition, the coalition is against potential medical loss ratio changes that would allow more state flexibility, as weakening standards could lower incentives for dental plans to increase access to care and shrink protections for beneficiaries.
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