July 12, 2013: California Insurance Commissioner Dave Jones (at left, in a 2011 photo by Katie Falkenberg for the LA Times) doesn't agree with how Covered California, the state's health insurance exchange, is handling the need for children to have dental care.
Chad Terhune, writing in the Los Angeles Times, reported Jones as saying that Covered California "is running afoul of federal and state laws" essentially disregarding the fact that the federal Affordable Care Act includes pediatric dental services as one of 10 "essential health benefits."
Under the spotlight, Peter Lee, executive director of Covered California, said they are still "examining various options for children's dental coverage...and flatly rejected any notion that the exchange is skirting the law."
Meanwhile, annoyed with advocates' proposals for bundling general health care with dental care, Assembly Dan Logue (R-Marysville) told the Sacramento Bee this week that many older people with no children have a hard enough time paying for their own health care, much less subsidizing pediatric dental care.
Children's advocacy groups,, lead by Kathleen Hamilton of the Children's Partnership and Anthony Wright of Health Access California, are working to get Covered California to embed medical and pediatric dental care into a single policy, "with premiums cut by charing the same price to families with children and without," according to the Bee article, written by Jim Sanders.
As it stands now, while "various options are still being examined":
...Unlike other key medical services, California families considering the purchase of pediatric dental insurance next year:
• Will not be fined for failing to acquire it.
• Will not be eligible for federal subsidies to ease costs to low-income households.
• Will not find an insurance policy on California's new health care exchange that combines kids' dentistry with coverage for the nine other essential health benefits, including hospitalization and prescription drugs.
The bottom line is that low-income families buying pediatric dental insurance through the state's online exchange, Covered California, will pay an extra monthly premium and potentially more out-of-pocket expenses...
Covered California recently announced that it had chosen five firms to sell "stand-alone" pediatric dental coverage and one firm to sell a "bundled" plan that separately provides dental and health care coverage beginning Oct. 1.
Monthly premiums will range from about $10 to $40 per child, but purchase is not mandatory. Policyholders will pay separately for the dental plan and will incur up to $1,000 in annual out-of-pocket expenses per child.
For medical insurance, the exchange provides federal subsidies on a sliding scale to Californians with annual incomes ranging up to $45,960 for an individual and $94,200 for a family of four.
No subsidies are available for stand-alone or bundled pediatric dental coverage....
"The exchange has gone 20 steps further than that and has directed the health insurers and HMOs to pull embedded pediatric dental out of their health plans and health insurance, which is not allowed under federal or state law," Jones said.