SB12-108, Oral Health Services to Pregnant Women Enrolled in Medicaid

SB12-108

PROVIDING ORAL HEALTH SERVICES TO PREGNANT WOMEN WHO ARE ENROLLED IN MEDICAID

Sponsor:  Senator Nicholson

Staff Name: Laura Brown

What the Bill Does:
SB12-108 amends current law¹ to add dental services as a benefit to pregnant women who are under Colorado’s Medicaid program. Qualified women will be able to receive dental care while pregnant and for 60 days after giving birth. The reasons for proving optional dental services, as stated in the bill, are as follows: untreated oral health conditions involving bacterial infections can result in medical complications that impact a woman’s pregnancy; a pregnant woman’s poor oral health can result in complications for the fetus, including low birth weight and pre-term delivery; low birth weight babies can have continual health problems, which can be at a significant cost for the Medicaid program; and a mother who has untreated bacterial infections of the mouth may expose her children to such bacteria, which could impact the child’s oral health. Further, a mother who has poor oral heath may give her child inadequate instruction about oral hygiene.

According to the bill, providing a dental services benefit to pregnant and postpartum women will improve the health of these women and their children, which promotes savings in the Medicaid program. Women will be eligible for the following services: oral hygiene education and instruction; screening, diagnosis, and treatment; treatment to prevent cavities; and the prevention of gum disease related services.

The department of health care policy and financing (state department) is charged with determining the most cost-effective method for providing dental services, including but not limited to, a comparison of a fee-for-service method of payment and the purchase of dental insurance. The state department shall also seek any federal authorization necessary to provide the dental services, and shall report to the Joint Budget Committee of the General Assembly and health-related committees of the House and Senate about the implementation of the dental benefit program. By January 1, 2016, the state department is required to report about the implementation of the program and the oral health outcomes of women and their children under the program, including costs associated with the program. The report should also include updated information that was required in the 2015 report. The state department may contract for an independent evaluation of health outcomes and cost effectiveness of the dental benefit program.

Colorado Context:
There is currently no law in Colorado with regard to maternal oral health. This bill would add Section (r.5) to C.R.S. §25.5-5-202, which covers optional services for the categorically needy under Colorado’s medical assistance program. Section (r.5) would add dental services for pregnant women, pursuant to §25.5-5-207, which SB12-108 proposes to add. Section 25.5-5-207 outlines the dental services program for pregnant women, as noted above. The program will start no later than January 1, 2014.

National Context:

• The Pennsylvania Department of Health Oral Health Program targets the prevention and management of dental disease. The program targets at-risk populations including pregnant women and infants. The program is aimed at making dental care more accessible, usually through non-profit, community sponsored dental clinics that accept public insurance (Medicaid). The dental treatment is done for free or on a sliding scale fee.²
• Montgomery County, Maryland, provides general dental care services to pregnant women who are enrolled in the DHHS Maternity Partnership Program.³ The fee for dental services is $10.⁴
• Louisiana provides dental services for pregnant women under its Expanded Dental Services for Pregnant Women program.⁵ The woman must be pregnant and be Medicaid eligible for full benefits to qualify for the program. The program covers exams, cleanings, certain gum related services, and some oral surgeries. Eligibility ends at the conclusion of the pregnancy.
• California passed legislation in 2005 – SB 377 – to provide dental prevention and treatment services to pregnant women, to reduce the risk of low birth weight babies and pre-term delivery. California has estimated that for every $1 spent on dental cleanings and basic treatment for pregnant women, between $1.11 and $1.35 is saved by avoiding neonatal intensive care services.⁶

Bill Provisions:

• Adds (r.5) to §25.5-5-202 which provides dental services for pregnant women pursuant to §25.5-5-207
• Adds the entirety of §25.5-5-202, which outlines the dental services program
  • Dental services shall be available for pregnant women and postpartum women who are eligible for Colorado’s Medicaid program up to 60 days after giving birth,
  • Outlines the importance of dental care for pregnant women as a medical benefit to the mother and a benefit to the child and after it is born, both of which will likely be a long-term cost benefit for the Medicaid program
  • Pregnant women will be eligible for relevant dental services as provided to children under the early screening, diagnosis, and treatment benefit, in addition to other supplemental dental services
  • The state department is required to report to the General Assembly on oral health outcomes for pregnant women and their children as well as the associated costs of the program, and is authorized to contract for an independent evaluation of the program
  • The state department is authorized to receive gifts, grants, and donations to pay for federal authorization of the program; this provision is repealed after three years
  • The dental care program will be implemented by January 1, 2014

Fiscal Impact:  To cover the cost of the evaluation, the State department may seek and accept gifts, grants, and donations. There is currently no fiscal note available for SB12-108.

¹ Colo. Rev. Stat. Ann. § 25.5-5-202

² http://www.portal.state.pa.us/portal/server.pt?open=514&objID=557627&mode=2

³ http://www.montgomerycountymd.gov/hhstmpl.asp?url=/content/hhs/phs/index.asp

⁴ http://www.infomontgomery.org/Pages/SearchResult/Summary.aspx?PrgID=478

⁵ http://new.dhh.louisiana.gov/index.cfm/page/333

⁶ http://www.leginfo.ca.gov/pub/05-06/bill/sen/sb_0351-0400/sb_377_cfa_20050908_155558_sen_comm.html