ADEA State Update

Vermont Moves Toward Single-Payer System but Debates Adult Dental Coverage

(State Policy) Permanent link   All Posts

As you may recall, on May 26, 2011, Gov. Peter Shumlin (D-VT) signed into law H. 202 (now called Act 48). Act 48 created the Green Mountain Care Board (GMCB or Board) to guide transitions in Vermont’s health system. Act 48 established Vermont’s health insurance marketplace in alignment with the Affordable Care Act, but the law goes even further. By 2017, or when federal waivers allow, Vermont intends to launch a new system called Green Mountain Care. This new system will allow all Vermonters to have health coverage through a single system providing universal health care. 

As Vermont continues to move ahead in planning for the 2017 launch of its new single-payer system, the scope of adult dental benefits to be offered is still under discussion. There are currently differing views as to whether adult dental benefits will even be included. According to a senior official in the Vermont Department of Health, currently adult dental care is not included in the essential benefits package that the GMCB is developing for its new single-payer system. However, senior staff in the governor’s office has stated that adult dental will be included. Additionally, the state is grappling with how to construct a benefit package that takes a population-based approach and leaves flexibility for individualized treatment plans. [1]

In January 2013, the GMCB issued a request for proposals to “research the potential policy considerations, which if implemented hold promise to improve access, quality and cost effectiveness of the current oral health system.” In late 2013, the JSI Research and Training Institute, under contract with the GMCB, released its research study titled Green Mountain Care Board: Vermont Dental Landscape Study. The study explores various policies that could improve access, quality and cost effectiveness of the current oral health system in Vermont. Specifically, the study analyzes the following (this list is not exhaustive):

  • Establishing a dental director in the Department of Vermont Health Access;
  • Institutionalizing oral health professional participation in the GMCB committees;
  • Adopting new workforce models;
  • Increasing Medicaid eligible utilization and dentist participation in Medicaid through rate increases; and
  • Maintaining adult dental benefits as currently defined in Vermont’s Medicaid program. [2]

According to the study, “greater than half of Vermonters are without oral health insurance.” Further, the study also finds that “half of the primary care dentist population is age 55 or over, indicating that a large population of the Vermont dentist workforce is approaching retirement.” [3]

In response to Act 48, when the state legislature convenes for the 2015 session, it will be exploring financing mechanisms for the single-payer system. According to a report by Avalere Health, a consulting firm, Vermont may need up to $2.2 billion to finance the single-payer system.

ADEA will continue to keep its members informed as Vermont implements its single-payer system.

[1] For example, a population may need an average of two cleanings per year per person, however individualized treatment plans may identify people who need one cleaning per year and others who need three.

[2] Currently, Vermont’s Medicaid program offers adults a dental benefit limited to a cap of $510.00 per beneficiary per calendar year. Non-covered services include; cosmetic procedures; and certain elective procedures, including but not limited to: bonding, sealants, periodontal surgery, comprehensive periodontal care, orthodontic treatment, processed or cast crowns and bridges. Prior authorization is required for most special dental procedures. Finally, a $3.00 per visit co-payment is required for dental visits under Medicaid.  

[3] According to the study, half of the primary care dentist population amounts to 158 dentists.

Duggan Dental