CA Passes Bill on Orthodontic Coverage
On Sunday, October 11, 2009, California Governor, Arnold Schwarzenegger signed SB 630 into law, providing assistance to the many children with cleft palate and related conditions in California. This important bill clarified that reconstructive surgery medical coverage shall include medically necessary dental or orthodontic services for cleft palate (“cleft palate” in the legislation means a condition that may include cleft palate, cleft lip, or other craniofacial anomalies associated with cleft palate). Although Medicaid in all states provides orthodontic treatment for children born with congenital orofacial defects (the crisis here being lack of providers), privately-insured patients are spending significant out-of-pocket expenses for what is deemed “dental” treatment and thus not covered by their health insurance. Indeed, some children have not been able to proceed with treatment due to lack of ability to pay for the necessary pre-surgical or post-surgical orthodontic care.
In 2008, Dr. William Hoffman, craniofacial surgeon at UCSF and President of the California Coalition of Cleft and Craniofacial Teams brought this issue to the California Society of Plastic Surgeons (CSPS) who adopted this effort with enthusiasm. Dr. Deborah Johnson, then President of CSPS, was instrumental in garnering professional support and providing medical testimony. The bill was initially sponsored by Senator Darrell Steinberg in 2008 (to become Senate President Pro Tem in 2009), and despite significant bipartisan support, was vetoed by Governor Schwarzenegger along with a host of other health “mandates.”
In 2009 the legislation was re-written as a “clarification” of the Reconstructive Surgery Act and was met again with significant bipartisan support and, with efforts of many through the state, resulted in the bill being signed into law. Several members of the UCSF craniofacial team testified before various legislative committees supporting the case for medical necessity and bringing the stories of children and their families into the policy debate. One young patient from UCSF spoke eloquently of his history of treatment and parents’ sacrifices to assure his medical treatment over the years. Additionally, clinics throughout the state spread the word and families, children, members of Cleft Advocate/AmeriFace, the Cleft Palate Foundation and the Native Sons of the Golden West all lent their valuable support to this important effort.
California now joins Florida, Indiana, Minnesota, South Carolina, Virginia and Connecticut in similar legislative clarification and hopes that other states will continue their efforts in legislative advocacy on behalf of the many children and families affected by cleft lip/palate and other craniofacial anomalies.
The actual language of the bill includes the following:
As of July 1, 2010, “reconstructive surgery” shall include medically
necessary dental or orthodontic services that are an integral part of
reconstructive surgery, as defined in paragraph (1), for cleft palate
procedures.
(3) For purposes of this section, “cleft palate” means a condition that
may include cleft palate, cleft lip, or other craniofacial anomalies associated
with cleft palate.
Last Updated: Oct 28, 2009