Maryland Sends Bill to Gov. Requiring Study of Medicaid Dental Benefits

The Maryland General Assembly sent a bill to Gov. Wes Moore (D) that requires the state’s Department of Health to study the feasibility of including coverage under the state’s Medicaid program for removable full and partial dentures and setting adequate reimbursement rates for providers on a per-patient basis. The bill also requires reimbursement rates for these services to be set at no less than 60% of the average commercial rates for all payers in the state who offer the services. The Department of Health will be required to report its findings by Dec. 1, 2024. It will also solicit input from state chapters of national professional dental organizations and advocacy groups that work to improve the oral health outcomes for the state’s low–income residents.

CMS Releases Final Rule Allowing States to Choose Adult Routine Dental Coverage as an EHB

The Centers for Medicare & Medicaid Services (CMS) released the 2025 Notice of Benefit and Payment Parameters final rule. The rule is designed to enhance accessibility and reliability within the Affordable Care Act (ACA) Marketplaces. These policies aim to simplify the enrollment process for low-income individuals, expand access to routine adult dental services and establish network adequacy standards to ensure reasonable travel distances to in-network providers. The rule builds upon previous efforts by the Biden administration to improve the quality and affordability of health care while standardizing operations across Marketplaces for increased consumer consistency.

One significant aspect of the new policies is the expansion of access to health care services, particularly the inclusion of adult routine dental care as a state option. Effective Jan. 1, 2027, states can include adult routine dental services as an essential health benefit (EHB) within their plans offered through the ACA Marketplaces. However, states can begin the EHB benchmark application process on Jan. 1, 2025. This move marks a notable step forward in prioritizing oral health by covering services like cleanings, X-rays, fillings and root canals. Additionally, the final rule sets out network adequacy standards for all providers to ensure that consumers can access in-network providers within reasonable time and distance parameters, enhancing the overall quality of care available through the Marketplaces.

Moreover, the rule focuses on making it easier for individuals to enroll in coverage, particularly through special enrollment periods (SEP) and streamlined enrollment processes. The SEP has been extended to allow consumers with household incomes at or below 150% of the Federal Poverty Level (FPL) to enroll in coverage during any month, rather than solely during the Open Enrollment period. Furthermore, efforts have been made to align Open Enrollment periods across Marketplaces and prevent coverage gaps during transitions by enabling coverage to begin promptly after selection. Streamlining measures, such as standardizing operations and providing live call center assistance, aim to enhance the consumer experience and ensure smoother enrollment processes across all Marketplaces.