The Adult Dental EHB Regulation Is Rescinded: Let’s Start Over

By Mike Adelberg, NADP Executive Director

On May 15, the Centers for Medicare and Medicaid Services (CMS) finalized its Notice of Benefits and Payment Parameters (NBPP), its annual regulation focused on the insurance markets regulated for the Affordable Care Act. In this regulation, the Trump Administration followed up on its proposal to rescind a 2024 Biden Administration regulatory provision that gave states the opportunity to add adult dental coverage to their Essential Health Benefits (EHB) benchmark. This provision, which was never implemented by a state, might have brought dental coverage to thousands (potentially millions) of people who lack coverage today.  

NADP supports the Trump administration’s decision to rescind the adult EHB provision, though I write this with mixed feelings. It is central to the mission of the National Association of Dental Plans (NADP) to see more people with dental coverage.  But the coverage has to be affordable and high quality. Alas, as first blogged two years ago, the 2024 adult dental EHB regulatory construct was a Jenga Tower that could not stand. It was fundamentally flawed in two ways: 

Contrary to Intent of the ACA: The Affordable Care Act requires Essential Health Benefits to be based on “typical” employer plan coverage. The 2024 adult dental EHB regulation stipulated that dental coverage must be embedded in a medical plan, a construct so atypical that it exists for only one percent of commercially-insured Americans. Further, the regulation dumped adult dental into the ambulatory benefits category, a construct so atypical that NADP has been unable to locate a single state or federal insurance filing that treats dental services this way.  

Weaker Dental Coverage: Though not the intention of the Biden Administration, the adult dental regulation would have—if implemented—resulted in weaker dental coverage for consumers. In the interest of brevity, I discuss only two problems below:  

• Adult dental coverage could place no-cost preventive dental services inside of large medical deductibles, making the $0 preventive coverage commonly available today costly for consumers. Consumers would be pressured to skip their dental check-ups and cleanings. 

• Medical plans would have, inevitably, sought the least expensive way to meet EHB benefit requirements. The likely result would be the widespread adoption of low-cost, narrow network dental HMOs (only 10% of the market today) instead of flexible PPOs (88% of the market). Thousands of consumers would have lost their longtime dentist.  

Three states—California, Kentucky, and Virginia—tried to make the adult dental EHB regulation work through different processes and with different end-products in mind.  EHB math is zero-sum and tricky. None of the three states could make it work. The Jenga Tower crumbled due to its own unwieldy construction. 

While NADP supported the recission of the 2024 adult dental EHB regulation, we do not celebrate this outcome. We recognize that many organizations view adult dental EHB as a meaningful pathway to expand oral health access and; we look forward to working collaboratively with CMS, states and oral health stakeholders on a new adult dental EHB construct built on: 

• Typicality: Consistent with the requirements of the ACA, adult dental benefits included in a state’s EHB benchmark should be “typical” with regard to how dental coverage is offered today. 

• Consumer Protections: Any resulting adult dental EHB should incorporate consumer protections in place today including $0 preventive care and the open access coverage models commonly chosen by consumers and employers. 

NADP looks forward to constructively participating in future conversations about adult dental EHB and expanding access to oral healthcare.