Federal Health Care Benefits Rule Allows States to Expand Dental Care, Streamlines Essential Health Benefit Standards

Federal Health Care Benefits Rule Allows States to Expand Dental Care, Streamlines Essential Health Benefit Standards

Washington, DC – The U.S. Department of Health and Human Services (HHS) just released its final rule for the Notice of Benefit & Payment Parameters for plan year 2025 (2025 NBPP), which includes important changes to policies around Marketplace eligibility and enrollment, as well as policies regarding coverage of services. In particular, the 2025 NBPP makes important changes to coverage of the Essential Health Benefits (EHBs) under the Affordable Care Act (ACA), which apply to Medicaid expansion plans, Marketplace plans, and all other non-grandfathered individual and small-group market plans. The 2025 NBPP streamlines and simplifies the state benchmarking process whereby states set EHB standards and minimum coverage requirements. Under the 2025 NBPP, states will also now have the opportunity to include oral health services for adults as part of EHB.

“Allowing states to provide adult dental as EHB is a game changer,” says Wayne Turner, a senior attorney at the National Health Law Program. “Oral health care, which remains out of reach for many, especially low income people, is inextricably linked to overall health, from cardiovascular disease to black maternal mortality. By improving access to oral health services for adults, the Biden-Harris Administration has taken a significant step forward in addressing unmet health needs and advancing health equity.”

NHeLP has long advocated for HHS and states to improve and expand access to needed services through EHB, which can help address conditions that disproportionately impact Black, Indigenous, and Other People of Color (BIPOC), LGBTQIA+ individuals, people with disabilities, and other underserved communities. In September 2023, NHeLP sent a letter to HHS discussing the legal and policy basis for allowing states to include non-pediatric oral health services as EHB.

“The 2025 NBPP simplifies and streamlines processes and benchmarks that will make it easier for states to enact policies to make these critical services available to more people,” said senior attorney Héctor Hernández-Delgado. “States should have incentives to make health care services more accessible, not less, and the 2025 NBPP takes significant steps to do just that. We are excited to work with and educate national and state advocates on how the EHB changes can be leveraged to make health care access more equitable and impactful for individuals and communities across the country”

You can learn more about the proposed 2025 NBPP in this NHeLP Explainer.

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