The ELSA was created to help children suffering from congenital anomalies or birth defects get the dental and oral care treatment they need.
Senators Tammy Baldwin (D-Wis) and Joni Ernst (R-Iowa) and Representatives Anna Eshoo (D-Calif) and Drew Ferguson (R-Ga) recently reintroduced the Ensuring Lasting Smiles Act (ELSA), which ensures that health plans cover medically necessary services related to a patient’s anomaly or birth defect, including any serious dental and oral-related procedures that are necessary to maintaining health and overall function.
The American Association of Orthodontists (AAO) and American Dental Association are part of a broad coalition of national health care professionals and patient advocacy organizations supporting the legislation. The Act reportedly has been a legislative priority for the AAO for several years.
Senators Sherrod Brown (D-Ohio) and Lisa Murkowski (R-Ark), who are also reportedly leading the efforts on the legislation, support ELSA, along with 25 other original co-sponsors in Congress. In the House, there are 132 original co-sponsors.
Congenital anomalies are typically covered in group and individual health plans, and many states require insurers to provide coverage of any health services related to congenital anomalies or birth defects. However, health plans often deny or delay claims and appeals for treatment of congenital anomalies by categorizing certain treatments or body parts as cosmetic or not medically necessary. Families are then required to pay for their child’s fnecessary treatment or procedures, including medically necessary orthodontic treatment, to restore their ability to function.