Many Americans are concerned about health insurance coverage and access to affordable health care where and when they need it. Less attention is paid to access to, and affordability of, dental care, yet proper dental hygiene and preventive dental care are critical aspects of maintaining oral health and overall well-being.
The National Academy of State Health Policy (NASHP) has published a primer and resource guide on partnerships between state Medicaid agencies and “safety net” dental providers. The publication recommends three strategies for states, Medicaid agencies, and safety net providers such as health centers, school-based health centers, and Ryan White HIV/AIDS Program grantees that can be used to improve access to dental care for Medicaid enrollees and other low-income and vulnerable populations. The following summarizes the strategies recommended by NASHP in the primer:
1. Augmenting the Dental Health Workforce
According to the federal Health Resources and Services Administration (HRSA), approximately 10 percent of the U.S. population lives in a dental health professional shortage area. One approach to easing the shortage of professionals and increasing access to dental care is for states to expand or create new roles for individuals who are not dentists but are part of the dental workforce, and for state Medicaid agencies to update their credentialing and reimbursement policies accordingly so that services provided by these professionals in augmented roles are reimbursed under Medicaid. Because states set their own scope of practice laws that dictate which services each dental health profession is licensed to provide, the states must amend their laws in order to expand the types of services that each profession can perform under their license.
For example, NASHP points to Colorado and Maine, two states that have expanded their scope of practice to allow dental hygienists to practice independently within the scope of their license, without the supervision of a dentist. In Colorado, hygienist-owned practices can provide routine preventive care, such as prophylaxis and sealant application for children. The similar creation or expansion of licensed services that can be provided by community dental health coordinators and dental therapists can also help to relieve the shortage of dental health professionals.
Similarly, the Network for Public Health Law identified expanding the scope of practice for dental professionals as one strategy to provide essential services to millions of Americans who currently do not have adequate access to oral health care.
2. Building Physical and Virtual Infrastructure to Deliver Dental Services
In addition to expanding the roles of dental health professionals, the physical spaces where dental health professionals practice can also be improved to provide services to more patients, such as through the establishment or expansion of community-based dental facilities, freestanding dental clinics, school-linked dental facilities, mobile or portable dental clinics, and tele-dentistry programs. NASHP advises that states may want to consider aligning Medicaid reimbursement with mobile and community-based dentistry initiatives in order to reach populations who otherwise may not have access to services, such as children.
3. Oral Health and Primary Care Integration
In alignment with the Health Resources and Services Administration’s 2014 report, Integration of Oral Health and Primary Care Practice, NASHP lists the integration of dental care as part of an individual’s primary care services as a strategy that may lead to better access to dental health care. The primer recommends developing a payment methodology that supports integration, such as allowing Federally Qualified Health Centers to bill for both a medical and dental encounter in the same day. Although integrating dental care into the primary care setting requires investments in training, workflow, and infrastructure, integration may be a key to alerting Americans that dental health care is part and parcel to overall health.
This post was prepared by Leslie Frey, Staff Attorney at the Network for Public Health Law–Eastern Region at the University of Maryland Francis King Carey School of Law.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this post does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.