New laws are being introduced and passed this year to increase coverage and accountability from dental insurers, with the backing of state and federal dental organizations.
In addition to holding insurers accountable, the bills aim to enhance access to care and support dental office operations.
Here are three ways legislation is addressing payer issues in the dental industry, and how dental groups are supporting these bills:
Dental loss ratios
Three states have enacted dental loss ratios so far this year: Montana, North Dakota and Washington. These DLRs are meant to ensure insurers spend a certain amount of premium dollars on patient care and claims versus administrative costs.
The National Council of Insurance Legislators, with the support of the American Dental Association, provided final approval for model legislation for a dental loss ratio last year. This model legislation was most recently used to help the Montana Dental Association get a DLR passed for their state earlier this year.
“[The model legislation] goes beyond reporting because it guarantees enforcement — meaning if a dental plan repeatedly reports loss ratios that are too low, it will have a loss ratio imposed on it by the state. So, one way or another, dental plans will have to provide more value to patients by paying out more for their care,” Former ADA President Linda J. Edgar, DDS, said in April 2024.
Several other states have introduced legislation this year to add their own dental loss ratios, according to the ADA.
Reimbursement increases
Arkansas recently enacted a law increasing Medicaid dental reimbursement rates for the first time in 18 years. Services getting reimbursement boosts under the new law include oral surgeries, as well as dental care for children and adults with special needs.
North Carolina House Bill 60 was filed in February to increase Medicaid reimbursement rates for dentists. The bill has not yet been passed by the state’s House of Representatives.
Increased coverage
Efforts have been made at the state and federal level to require insurers to cover certain services.
The Ensuring Lasting Smiles Act was reintroduced to Congress May 8 to require insurers to cover needed services for individuals born with congenital anomalies or birth defects. The ADA also recently wrote an open letter to third-party insurers, Medicaid agencies and employer groups urging them to cover preventive dental services. The letter pushed for insurers to cover services across patients’ lifespan, including fluoride treatments, dental sealants and regular periodontal care, citing the link between oral health and other issues.
At the state level, Arizona and Illinois are considering legislation to enhance dental coverage. Arizona Senate Bill 1347 would expand the state’s adult Medicaid coverage to include comprehensive dental benefits. The bill currently sits with the state’s House of Representatives.
Illinois Senate Bill 1392 would require dental insurance companies to cover dental visits immediately. Current legislation does not specify if insurers have to pay the providers directly or reimburse the patient for a visit, leading to delays in reimbursements to patients. The bill has been passed by both the House and Senate.
