Why Alberta's government wants out of the federal dental care plan and who it could impact

Late last month, Alberta Premier Danielle Smith sent a letter to Prime Minister Justin Trudeau, stating that Alberta would pull out of the federal government's dental care plan by 2026.

Instead, the province would seek a negotiation to secure Alberta's share of federal funding to reshape dental care coverage as it sees fit.

The Canadian Dental Care Plan (CDCP) provides coverage for those without dental benefits and a household income of less than $90,000, and has started to openin phases.

Though Alberta is seeking to secure the funds allocated to that program, there is actually no agreement signed with Alberta. The federal program is administered by Sun Life Financial, anddentists who sign up under the CDCPare reimbursed by Sun Life.

The premier's view is that dental care falls under provincial jurisdiction, and that Alberta is better equipped to address its own residents' needs through its own programs with federal funding support.

The federal government, on the other hand, argues the CDCP is intended to complement existing dental programs and to fill existing gaps in coverage.

It suggests that the number of Albertans who have already signed up for the program more than 100,000, according toMatthewKronberg, a press secretary for federal Health Minister Mark Holland illustrates why it is necessary.

That said, the federal health ministry has indicated it would considerthe idea of Alberta expanding its own coverage.

"We are open to discussing Alberta's request to opt out of the program so long as Albertanscontinue having access to the same level of care as CDCP members across the country," Kronberg wrote in an email.

Andrea Smith, a spokesperson for Minister of Health Adriana LaGrange, said Alberta is proceeding in negotiations with the federal government for its share of federal dental funding.

"Negotiations will include a review of who is covered by the CDCP, who is covered by Alberta's programs and how we can work together to expand coverage for more Albertans," Smith wrote in an email.

Dental care in Alberta

It's true that Alberta already has a variety of provincial plans tied to dental care, including:

• The Alberta Child Health Benefit provides coverage for dental care for children in low-income households.
• The Alberta Adult Health Benefit covers dental benefits for adults in low-income householdswho are pregnant or have high ongoing prescription drug needs.
• Dental assistance is available for seniorsbased on income.
• Assured Income for the Severely Handicapped (AISH) includes coverage for Albertans with permanent medical conditions.

In the end, who isn't covered under those plans varies each plan is quite precise in terms of where income thresholds lie.

Take the Dental and Optical Assistance for Seniors program, for instance. To qualify, asenior couple must have an income below $66,820.

Or, consider the Alberta Adult Health Benefit. A couple with four children can qualify for the benefit with a maximum net household income of $46,932.

A couple with two kids would qualify should they make less than $36,634 per year.

The Alberta Child Health Benefit istied to the same maximum income guidelines. A couple with four children could qualify under both programs with a maximum net household income of $46,932, with theparents covered under the adult program and the children under the child program.

But there is no duplication allowed, theAlberta Dental Association notes that family couldn't combine the coverage as one person over two programs.

Alberta contends it offers the most extensive, publicly funded dental coverage in Canada, benefiting around 500,000 Albertans. That includes 240,000 qualifying under dental assistance for seniors, 64,500 under the Alberta Adult Health Benefit, 40,800 under the Alberta Child Health Benefit and 69,600 under AISH.

Others receiving benefits include59,800 through income support,5,500 through children and youth support, and16,800 Ukrainian evacuees.

Hans Herchen, president-elect of the Alberta Dental Association, largely agrees with theassessment that Alberta offers the most extensive dental coverage in the country.

"We haven't formally validated that, line item by line item. But I can confirm that there is significantly more dental coverage provincially in Alberta than in most provinces," Herchen said.

Income thresholds pose concerns for some

Premier Danielle Smith in her letter acknowledges the CDCP has led to more Albertans becoming eligible for coverage under the new federal plan.

Take individuals seeking coverage under the Alberta Adult Health benefit, for example. To qualify, acouple with four children would have to see a maximumnet household income of$46,932.

"I think [$46,932]is really low for a threshold," saidAmeera Shivji with Vibrant Communities Calgary, apoverty reduction organization.

"That[$46,932]doesn't cover a lot of people that would be in real need for this program."

Given the CDCP's $90,000 adjusted family net income threshold, more families would be captured above theAlberta Adult Health benefit's cutoff.

But still, in Alberta, manyview a $90,000 household income as not being especially high given the rising cost of living.

"Living in Alberta, $90,000 for families is still a precarious income that would make you think hard about what you're spending your money on," said Fiona Clement, a professor at the University of Calgary in the department of community health sciences.

Shivjiagreed, adding people working in the sector often hear of challenges and trade-offs amid a rising cost of living.

"Sometimes, it's a choice between food and shelter. Right now, our shelter costs are rising like crazy," Shivji said.

"When it comes to trade-offs, dental care is often going to be the one that is traded off. Often when people don't have insurance, they're likely not to get care."

A cluttered landscape

The difference in income thresholds in Alberta coverage compared to federal plans doesn't mean the province should embrace the CDCP, in the view of the Alberta government.

That's because, simply put, the province wants to take what's on offer in federal dollars and allocate it towardcoverage it manages, enhancing or supplementing existing coverage plans.

"We need to work together with the federal government to ensure we are not duplicating existing services and focus on expanding our current program instead," wrote Andrea Smith, the spokesperson in Alberta's health ministry.

In response to a followup question inquiring whether the province would commit to matching levels of coverage available under the CDCP should it secure its share of federal funding, Smith said specific details of the expansion would be confirmed through negotiations.

Dental coverage is very piecemeal and confusing, with different coverage for different kinds of programs, Clement noted.

There are various programs on offer from the Alberta government. But many Albertans will also be familiar with private insurance plans offered through their employer, or with plansthey've purchased.

But this has been the way the landscape has functioned for many years, she noted.

"It's a complicated landscape, but I'm very confident people can figure it out," she said.

Provincial jurisdiction

In addition to stating that the CDCP was inferior and wasteful compared to Alberta coverage, the premier has taken issue with what she views as yet another federal government incursion into provincial jurisdiction.

"Health care planning and delivery is an area of provincial jurisdiction, and the new federal plan infringes upon this exclusive jurisdiction," Danielle Smith wrote.

"If a new health program was to be developed by the federal government, it should be done in full collaboration with provinces and territories, and discussions should have occurred before these intentions were announced. Unfortunately, this did not occur."

Dental care is often a forgotten piece of health care, in the view of Clement. As with all health care, the federal government does not have jurisdiction to operationalize or deliver dental services.

"But here, we're not actually talking about delivering health care at all, we're talking about funding. This is a payment mechanism," Clement said.

"That is totally within the federal government's wheelhouse to fund health-care services."

First phase of Canada's national dental care plan begins

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The first phase of the Canadian Dental Care Plan began on May 1, providing coverage to nearly two million seniors aged 70 and older.

Clement said the premier's contention that a new health plan should have been developed by the federal government in collaboration with provinces and territories was a very fair criticism.

She added it was likely the federal government wanted to get the process started and get money flowing.

"It doesn't do Albertans any good to have two governments arguing over who's going to pay the bill at the end of the day," she said.

Of course, it's also unclear if the CDCP will even survive long enough for Alberta to opt out of it by 2026.

Conservative Leader Pierre Poilievre hasn't committed to keeping the program should he win the next election.