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Anesthesia Coverage for Children

The Massachusetts Dental Society believes that all Massachusetts residents, including the most vulnerable, should have access to necessary oral health care. An Act Relative to Dental Anesthesia would require health care plans to provide coverage for anesthesia and outpatient treatment for dental care for children with disabilities, certain medical conditions, and all children under the age of six.

The Issue

To receive proper and safe dental treatment, hospitalization and general anesthesia are often necessary for young children and people with special health conditions who have difficulty undergoing long dental procedures. These patients are prone to involuntary movements and risk suffering serious injury from sharp instruments in the mouth. General anesthesia renders a patient temporarily unconscious to prevent discomfort, pain, and movement that can affect the safety and outcome of the treatment process.

Current Massachusetts law allows private insurers to refuse reimbursement for general anesthesia and hospital costs in these cases, with the insurers citing the procedures as not medically necessary. As a result, many of these patients delay or forgo necessary dental treatment because their families cannot afford hospital and anesthesia fees, leading to lifelong negative health impacts and often, higher net medical costs.

While MassHealth currently covers the cost of general anesthesia, many children in the Commonwealth are ineligible and do not receive necessary care.

Key Facts

  • According to the Department of Public Health, 26% of all children under the age of seven in Massachusetts have special health needs. 
  • Children who have delayed dental extractions because they are unable to receive general anesthesia suffer further pain. The International Journal of Paediatric Dentistry published one study of a six-month waiting period between diagnosis and treatment where 49.4% of the children required antibiotics, 28.5% suffered disturbed and irregular sleep patterns, and 32.9% had problems with eating. 
  • At least 32 states have enacted legislation requiring private insurers to cover anesthesia for children hospitalized for dental treatment. 
  • A study conducted after legislation was passed in North Carolina in 2000 revealed a 60% increase in non-Medicaid visits and a 33% increase in Medicaid visits, with 43% more children overall seeking dental care.  
  • When Louisiana passed comparable legislation in 1997, a leading national medical insurance company indicated that the new law increased the cost of plans by less than 0.2%. This legislation would similarly allow increased access to care for vulnerable, special-needs patients without a significant cost increase.

Legislative Solution

To enable children with disabilities, certain medical conditions, and all children under the age of six to receive the dental care they need, An Act Relative to Anesthesia Coverage for Children Hospitalized for Dental Treatment would require health care plans to provide coverage for general anesthesia administered by an anesthesiologist in a hospital.