For Immediate Release: November 15, 2023 

Contact: Jack Cardinal, jcardinal@communitycatalyst.org, (781) 960-5208

Biden administration takes important step in addressing coverage gaps and inconsistencies in essential health benefits  

“Our teeth are essential and it is past time that our policies address the gaps and inconsistencies that exist in coverage. We are grateful to the Biden administration for taking this important step forward.” – Mona Shah 

Boston, MA – Community Catalyst and a growing network of 50+ partners advocating for the Biden administration to address gaps and inconsistencies in essential health benefits (EHBs), celebrate a win this evening, with the announcement that the Centers for Medicare & Medicaid Services (CMS) is taking important steps forward to remove barriers to coverage for adult dental care. Dental services are a leading driver of medical debt – with thousands of people sharing their stories about the need to make this simple, yet important update. Learn more about Community Catalyst’s advocacy campaign to update the EHBs. 

Community Catalyst senior director of policy and strategy Mona Shah released the following statement:  

“This is a celebratory moment in our ongoing efforts to make health care more affordable, comprehensive, and accessible to people – because nobody deserves to go into debt simply because they got sick or seek care. Our teeth are essential and it is past time that our policies address the gaps and inconsistencies that exist in coverage. We are grateful to the Biden administration for taking this important step forward.  

“Put simply: No insured person should be underinsured. Beyond dental, we are hearing from people every day, from communities across the country, that want insurance to work for them. As more people get covered, it’s critical that the Biden administration continues to address the gaps and inconsistencies that exist – including for mental health, maternity, and gender-affirming care.  

“These are simple but important and long overdue changes to improve coverage for millions of people across the country.” 

Background on Community Catalyst’s campaign:  
  • In March, Community Catalyst executive director Emily Stewart painted a clear picture of the need to address gaps and inconsistencies. Read her perspective.  
  • In July, a coalition of more than 50 organizations joined Community Catalyst to urge the Biden administration to strengthen health care coverage. Read the letter.  
  • Last week, Mona Shah made clear the opportunity ahead as more people get enrolled in coverage through open enrollment, yet continue to experience gaps and inconsistencies. Read the opinion piece in The Hill.  
  • People like Presly experience these gaps and inconsistencies in their everyday life. Watch their video.  
  • More than 16,500 people have signed petitions from all 50 states, Washington, D.C. and Puerto Rico, demanding action. Sign the petition. 
  • Thousands of people have shared their personal stories, among them:  
    • “My dentist’s office threatened to have me arrested & jailed when I had trouble paying the bill for a tooth extraction that turned into urgent dental surgery. The dental receptionist demanded cash on the spot. I wound up not paying my other bills to get out from under the dental bill. This is NOT how I expected my life in retirement to be!” – Carol T., Wyoming 
    • “I stopped going to the dentist because my insurance only covered a small fraction of the cost. Now I’m losing my teeth and feel helpless because people who lose nine of their teeth are more likely to suffer a heart attack or stroke. We NEED dental coverage NOW!” – Crystal K., Arizona 
    • “I have been denied preventive care from dentists who would not accept Medicaid, and this led to dental problems becoming worse and more expensive. We need to make sure everyone gets the preventative care they need and this will mean we spend less money on dental problems in the long term.” – Joseph N., Michigan 
Background on the announcement from CMS:  

In the annual Notice of Benefit and Payment Parameters (NBPP) for 2025 that outlines new proposed rules for insurance sold on the ACA Individual and Small Group markets, CMS proposes to remove the regulatory prohibition on issuers from including routine non-pediatric dental services as an EHB, which would allow states to add routine adult dental services as an EHB by updating their EHB-Benchmark plans. Removing the prohibition on routine non-pediatric dental services as an EHB would expand access to adult dental benefits by removing respective regulatory and coverage barriers. This proposal would also give states the opportunity to improve adult oral health and overall health outcomes, which could help reduce health disparities and advance health equity since these health outcomes are disproportionately low among marginalized communities. Under this proposal, states would be permitted to include routine non-pediatric dental services as EHBs for purposes of their Alternative Benefit Plans (ABPs) or Basic Health Program (BHP) standard health plans.  Additionally, the NBPP proposes granting states enormous flexibility in crafting their own benchmarks and covering new state mandated benefits so that states are able to expand coverage without having to take on additional costs.  Read more here. 

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About Community Catalyst 

Community Catalyst is a leading non-profit national health advocacy organization dedicated to advancing a movement for race equity and health justice. We partner with local, state and national advocates to leverage and build power so all people can influence decisions that affect their health. Health systems will not be accountable to people without a fully engaged and organized community voice. That’s why we work every day to ensure people’s interests are represented wherever important decisions about health and health care are made: in communities, state houses and on Capitol Hill. For more information, visit http://www.communitycatalyst.org. Follow us on Twitter @CommCatHealth.