No matter how states operate the Children’s Health Insurance Program, they are obligated to include dental insurance. According to the federal government, tooth decay is one of the most common preventable chronic childhood diseases. Therefore, the federal government prioritizes offering dental insurance for kids. States have a variety of options to fund dental insurance through CHIP, which means program requirements and offers may differ between states.
Dental care for kids is a top priority in the United States. Children in low-income families can develop dental issues early in their lives is they do not regularly see a dentist. Poor dental care in a child’s young life can lead to serious long-term consequences, including losing teeth relatively early in his or her adulthood. Additionally, dental care can address more than just teeth and gums. Proper care can address birth defects, mouth conditions, cancers and more serious illnesses. Poor dental health is associated with lower overall health, which means maintaining oral health is a priority. The sections below describe the history of CHIP dental care, how states offer CHIP program benefits, the types of dental treatment is included and who meets eligibility requirements for dental assistance. You can also download our comprehensive guide for more information on CHIP dental insurance programs.
History of CHIP Dental Coverage
President Bill Clinton signed the Children’s Health Insurance Program into law in 1997 after months of negotiation. It was created to address controversial healthcare reform in the United States. Dental insurance was included as part of the program since its inception. However, not all children enrolled in CHIP received dental insurance in the bill’s initial language. Nevertheless, through CHIP, dental insurance rates for kids have slowly increased over the years. The dental uninsured rate for children has fallen steadily since CHIP was implemented, from just under 22 percent in 2000 to just over 12 percent in 2013.
In 2009, Congress passed the Children’s Health Insurance Program Reauthorization Act, which amended the program to be more comprehensive. The program expanded coverage to pregnant women and to legal immigrants who have lived in the country less than five years. Most importantly, it mandated that all children enrolled in CHIP receive dental coverage as part of the program. Today, the program helps nearly 9 million children a year obtain medical care, including dental care.
Learn About CHIP Dental Benefit Options
States deliver kids dental care with CHIP in different ways depending on how they fund the program. Some states pay for CHIP coverage through Medicaid expansion, while others have a separate CHIP program that receives federal funding. States can offer plans that meet any of the following requirements:
- Benchmark coverage – Benchmark coverage must be based on one of the following:
- Standard Blue Cross/Blue Shield Preferred Provider Option plan available to federal employees
- State employee coverage plan
- HMO plan with the highest non-Medicaid enrollment in the state
- Benchmark-equivalent coverage – This coverage must be actuarially equivalent to the benchmark coverage. To meet the definition, it must include certain benefits. Some of these required benefits include:
- Inpatient/outpatient hospital visits
- X-Ray services
- Well-baby and well-child care services
- Prescription drug coverage
- Mental health services
- Secretary-approved coverage – If states choose this option, they can offer coverage approved by the U.S. Department of Health and Human Services Secretary.
- EPSDT services – States that offer CHIP by expanding Medicaid must offer Early and Periodic Screening, Diagnostic and Treatment services. This type of coverage does include dental care for kids.
Your state may offer coverage through any of the above options. Benefits and coverage will vary from state to state depending on how they fund their program. To find out specific CHIP coverage options available in your state, you should contact your state’s department for CHIP benefits.
What dental coverage is included?
Under the Children’s Health Insurance Program, children should receive thorough dental coverage, including preventative treatment and more intensive care. Unlike adult dental care under Medicaid, the federal government has sent minimum standards for what dental coverage children should receive. However, the exact coverage options can vary significantly from state to state. Some states may require that children have insurance directly equivalent to insurance available for federal or state employees. Others may only require that the insurance is financially equivalent, and still others require that states meet Medicaid requirements. Although not a comprehensive list, some of the services covered include:
- Regular teeth cleanings and fluoride treatment.
- Oral health screenings and dental examinations.
- Tooth X-rays.
- Oral surgery.
- Sedation for surgery.
Different states will offer different treatment options. For example, some states may offer more frequent teeth cleanings than others. Some states may require prior approval for particular treatments, while other states may not require pre-approval to receive such treatments. All types of oral surgery may be covered by one state, while another only covers some kinds of oral surgery. If you applying to CHIP for your child, you should inquire with your caseworker what kind of dental coverage for kids is included in your state’s CHIP insurance.
Although states may cover a variety of services, many impose strict caps on the value of dental coverage for kids per year. Benefit limits can vary between states. For instance, Alabama offers up to $1,500 of benefits per year for dental services, not including the cost of preventative and diagnostic care. That means X-rays and cleanings may not count towards the maximum, but orthodontic services or oral surgery would. Beyond the annual maximum, beneficiaries must receive prior approval from the state. Other states may include the cost of preventative and diagnostic care, but not count orthodontic treatment. To learn more about dental insurance, download our comprehensive guide to CHIP.
Who can get CHIP dental insurance?
The Children’s Health Insurance Program is intended for children up to 19 years of age who are members of low-income families that may not qualify for Medicaid program benefits. Therefore, the program’s income requirements are less strict than the requirements to qualify for Medicaid. However, requirements are set from state to state, which means it may not be easy to determine if an individual family is eligible. In general, a family’s income should be somewhere between 200 and 400 percent of the federal poverty level (FPL) to qualify. Different states will have higher or lower limits depending on the local cost of living. For instance, New York can offer coverage to households with income at 400 percent of the FPL for CHIP-funded healthcare. West Virginia’s requirement can cap out as low as 133 percent for coverage for children between the ages of 6 and 18 years through CHIP-expanded Medicaid.