oral health and the affordable care act: state … health and the affordable care act: state...
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Oral Health and the Affordable Care Act: State RolesState Roles
Presenting:Caswell Evans Jr DDS MPH Director Associate Dean forCaswell Evans, Jr., DDS, MPH, Director, Associate Dean for Prevention and Public Health Sciences, College of Dentistry,
University of Illinois at ChicagoRebecca Alderfer, MPP, Manager, Strategic Initiatives,
Pew Center on the StatesSBobby D. Russell, DDS, MPH, Public Health Dental Director, Iowa
Moderated by Senator Jeremy Nordquist, NCSL Health Committee Chair NebraskaNCSL Health Committee Chair, Nebraska
This webinar is produced with generous support from the Pew Children’s Dental Campaign.
State Approaches and Policy State Approaches and Policy Options Regarding the OralOptions Regarding the OralOptions Regarding the Oral Options Regarding the Oral
Health of ChildrenHealth of Children
May 18, 2011May 18, 2011
Caswell A. Evans, DDS, MPHCaswell A. Evans, DDS, MPHAssociate Dean for Prevention and Associate Dean for Prevention and
Public Health SciencesPublic Health Sciences
University of Illinois College of DentistryUniversity of Illinois College of Dentistry
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ChildrenChildrenChildrenChildrenChildrenChildrenChildrenChildren
For each child without medical insurance, For each child without medical insurance, there are at least 2.6 children without dental there are at least 2.6 children without dental insuranceinsurance
Uninsured children are 2.5 times less likely Uninsured children are 2.5 times less likely th i d hild t i d t lth i d hild t i d t lthan insured children to receive dental care than insured children to receive dental care
Oral Health in America: A Report of the Surgeon General ~ DHHS 200033
Cleft Lip/PalateCleft Lip/Palate
Cl ft li / l t f th tCl ft li / l t f th t
Cleft Lip/PalateCleft Lip/Palate
Cleft lip/palate, one of the most Cleft lip/palate, one of the most common birth defects, is common birth defects, is estimated to affect 1 out of 600 estimated to affect 1 out of 600 live births for whites and 1 out of live births for whites and 1 out of 1,850 live births for African 1,850 live births for African AmericansAmericansAmericansAmericans
Oral Health in America: A Report of the Surgeon General ~ DHHS 2000Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
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Dental caries (tooth decay) is the single most Dental caries (tooth decay) is the single most ( y) g( y) gcommon chronic childhood diseasecommon chronic childhood disease---- 5 times 5 times more common than asthma and 7 times more more common than asthma and 7 times more
ffcommon than hay fever common than hay fever
Poor children suffer twice as much dental Poor children suffer twice as much dental caries as their more affluent peers, and their caries as their more affluent peers, and their disease is more likely to be untreateddisease is more likely to be untreateddisease is more likely to be untreated disease is more likely to be untreated
Oral Health in America: A Report of the Surgeon General ~ DHHS 2000Oral Health in America: A Report of the Surgeon General ~ DHHS 200055
Dental caries is one of the most Dental caries is one of the most common diseases among 5common diseases among 5-- to 17to 17--
ldld
Dental caries is one of the most Dental caries is one of the most common diseases among 5common diseases among 5-- to 17to 17--
ldldyearyear--oldsoldsyearyear--oldsolds
58.6Caries
8.0
11.1
Hay fever
Asthma
4.2Chronic bronchitis
y
0 10 20 30 40 50 60 70
Percentage of children and adolescents ages 5 to 17
Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
Note: Data include decayed or filled primary and/or decayed, filled, or missing permanent teeth. Asthma, chronic bronchitis, and hay fever based on report of household respondent about the sampled 5- to 17- year olds.Source: NCHS 1996
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Poor children 2 to 9 in each racial/ethnic group Poor children 2 to 9 in each racial/ethnic group have a higher percentage of untreatedhave a higher percentage of untreatedPrimary teeth than nonpoor childrenPrimary teeth than nonpoor children
Poor children 2 to 9 in each racial/ethnic group Poor children 2 to 9 in each racial/ethnic group have a higher percentage of untreatedhave a higher percentage of untreatedPrimary teeth than nonpoor childrenPrimary teeth than nonpoor childrenPrimary teeth than nonpoor childrenPrimary teeth than nonpoor childrenPrimary teeth than nonpoor childrenPrimary teeth than nonpoor children
67.4 70.557.256.1 56.9
0607080
prim
ary
ed p
er
37.3
20304050
deca
yed
e un
trea
tehi
ld
01020
Non- Mexican Non-
enta
ge o
f th
that
are c
HispanicBlack
American HispanicWhitePe
rce
teet
Poor Children Nonpoor ChildrenPoor Children Nonpoor ChildrenSource: NCHS, 1996
Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
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The “upside down” blproblem:
Children with most need h l thave least care
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The challenge is to:
1. Reduce disease burden
2. Improve access to quality care
The “fix” : Children with most need
get most care
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Why Policy MattersWhy Policy Matters
Policy change may be necessary when what has Policy change may be necessary when what has
y yy y
y g y yy g y ybeen tried so far is not successful in reducing been tried so far is not successful in reducing disparities in oral health statusdisparities in oral health status
Policy change can shift funds and programming Policy change can shift funds and programming towards preventive measures and facilitate better towards preventive measures and facilitate better
t t t tt t t taccess to treatmentaccess to treatment
Policy change related to oral health has thePolicy change related to oral health has thePolicy change related to oral health has the Policy change related to oral health has the benefit of strong evidencebenefit of strong evidence--based solutionsbased solutions
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A Few Trends in StatesA Few Trends in StatesA Few Trends in StatesA Few Trends in States
State mandates for dental screening forState mandates for dental screening forState mandates for dental screening for State mandates for dental screening for schoolschool--aged childrenaged childrenCommunity Water FluoridationCommunity Water FluoridationCommunity Water Fluoridation Community Water Fluoridation SchoolSchool--based/linked dental sealant based/linked dental sealant programsprogramsprograms programs Medicaid Reimbursement, Loan Medicaid Reimbursement, Loan Repayment & otherRepayment & otherRepayment, & otherRepayment, & otherFederal / State: Federal / State: CHIP, FQHCs, & State CHIP, FQHCs, & State ExchangesExchangesExchangesExchanges
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State LawsState Laws –– Dental “Screening”Dental “Screening”State Laws State Laws Dental ScreeningDental Screening
St t l th t i tifi ti f l h lth tSt t l th t i tifi ti f l h lth tState laws that require certification of an oral health assessment as a State laws that require certification of an oral health assessment as a condition of school entry:condition of school entry:
Overall, more than a quarter of states now have some requirement Overall, more than a quarter of states now have some requirement for a dental certificate for schoolfor a dental certificate for school--aged childrenaged children
Data needed to know if policy improves child health or family Data needed to know if policy improves child health or family health literacyhealth literacy
More information: More information: http://nmcohpc.net/2008/statehttp://nmcohpc.net/2008/state--lawslaws--dentaldental--screeningscreening--schoolagedschoolaged--childrenchildren
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IL Dental Screening LawIL Dental Screening Law
Students in public, private and parochial school must comply
All children in kindergarten, second and sixth grades are required to have a dental examination by May 15th of each year
Waiver is issued for religious undue burden and lack of access concernsWaiver is issued for religious, undue burden and lack of access concerns
Data is maintained by Board of Education and Department of Public Health
In the 2005 06 school year the first year of the new law the dental complianceIn the 2005-06 school year, the first year of the new law, the dental compliance level of all students in all reported schools was 80.3%. The compliance level of public schools was 78.8% and of non-public schools was 90.6%.
See: See: http://www.astdd.org/docs/FinalSchoolScreeningpaper10http://www.astdd.org/docs/FinalSchoolScreeningpaper10--1414--08.pdf08.pdf1313
Community Water FluoridationCommunity Water FluoridationCommunity Water FluoridationCommunity Water FluoridationFor every $1 invested in community water For every $1 invested in community water y $ yy $ yfluoridation, $38 is saved in dentalfluoridation, $38 is saved in dentaltreatment coststreatment costs. (CDC). (CDC)
The The Fluoride Legislative User Information Fluoride Legislative User Information ggDatabase (FLUID)Database (FLUID) is an online legal and is an online legal and policy database that is...policy database that is...
ComprehensiveComprehensiveUserUser--friendlyfriendlyyyInformativeInformative
Addresses policy and case law at federal, Addresses policy and case law at federal, state, and local levels. Available at state, and local levels. Available at ,,www.fluidlaw.orgwww.fluidlaw.org
SearchSearchCase LawCase LawPoliciesPoliciesFederal ActionsFederal Actions
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State Strategy ExampleState Strategy ExampleState Strategy ExampleState Strategy Example
Arkansas Statewide Law (Act 197)Arkansas Statewide Law (Act 197) ––Arkansas Statewide Law (Act 197) Arkansas Statewide Law (Act 197) ––fluoridation forfluoridation for approximately 32 additional approximately 32 additional community water systems in Arkansascommunity water systems in Arkansascommunity water systems in Arkansascommunity water systems in Arkansas
Took a “village” to pass:Took a “village” to pass:Took a village to pass:Took a village to pass:Coalition worked with CDC/CDHP Oral Health Coalition worked with CDC/CDHP Oral Health Policy Tool and prioritized policy changePolicy Tool and prioritized policy changePew Campaign StatePew Campaign StateMultiple partnersMultiple partners
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School based/linked dental sealant School based/linked dental sealant programs (SBSPs)programs (SBSPs)
CDC reports SBSPs can reduce decay by CDC reports SBSPs can reduce decay by up to 60%*up to 60%*up to 60%up to 60%
Yet only 32% of children aged 8 years haveYet only 32% of children aged 8 years haveYet only 32% of children aged 8 years have Yet only 32% of children aged 8 years have received sealants in the US and disparities received sealants in the US and disparities exist in receipt of sealants*exist in receipt of sealants*exist in receipt of sealantsexist in receipt of sealants
** CDC Oral Health Program Strategic Plan 2011CDC Oral Health Program Strategic Plan 2011 20142014 CDC Oral Health Program Strategic Plan 2011CDC Oral Health Program Strategic Plan 2011--20142014
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State Strategy ExampleState Strategy ExampleState Strategy ExampleState Strategy Example
In SC for example dental sealant usage amongIn SC, for example, dental sealant usage among 3rd graders increased 20 to 24 % from 2002 to 2008, with no racial disparity in status of sealant , p yuse (and untreated decay declined from 32% to 22%).
Oral health surveillance, infrastructure support & funding, + policy changes related to Medicaid reimbursement and workforce seen as contributing ffactors.
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Other OptionsOther OptionsIncrease Medicaid reimbursement rates toIncrease Medicaid reimbursement rates toIncrease Medicaid reimbursement rates to Increase Medicaid reimbursement rates to at least cover provider costs of delivery careat least cover provider costs of delivery care
Michigan Pilot: Commercial Carrier (Delta) Michigan Pilot: Commercial Carrier (Delta) representing Medicaidrepresenting Medicaidrepresenting Medicaid representing Medicaid
States with State supported Dental Schools:States with State supported Dental Schools:States with State supported Dental Schools:States with State supported Dental Schools:Loan repayment/forgiveness for establishing Loan repayment/forgiveness for establishing practice in an underserved areapractice in an underserved areapractice in an underserved areapractice in an underserved area
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State / FederalState / FederalState / FederalState / Federal
Children’s Health Insurance Program (CHIP)Children’s Health Insurance Program (CHIP)
Federally Qualified Health Center (FQHC) Federally Qualified Health Center (FQHC) y ( )y ( )public / private contractingpublic / private contracting
Affordable Care Act (ACA) State ExchangesAffordable Care Act (ACA) State Exchanges
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State focus on CHIPState focus on CHIPState focus on CHIPState focus on CHIP
Federal Children’s Health Insurance Program (CHIP) now Federal Children’s Health Insurance Program (CHIP) now provides comprehensive approach to oral health for kidsprovides comprehensive approach to oral health for kids
–– dental coveragedental coverage–– access to information on available providersaccess to information on available providers
i d t biliti d t bilit–– increased accountabilityincreased accountabilityOptional state policy, states with separate CHIP plans Optional state policy, states with separate CHIP plans may provide supplemental dental coverage to CHIP may provide supplemental dental coverage to CHIP y p pp gy p pp gincomeincome--eligible children with medical coverageeligible children with medical coverage–– Iowa only state that has currently implementedIowa only state that has currently implemented
See:See:http://www.cdhp.org/resource/access_child_only_supplemental_dental_coverage_through_chiphttp://www.cdhp.org/resource/access_child_only_supplemental_dental_coverage_through_chipra_handbook_advocates_and_policyra_handbook_advocates_and_policy 2020
PublicPublic--Private Partnerships:Private Partnerships:FQHC Contracting for Dental ServicesFQHC Contracting for Dental ServicesFederal legislation clarified that Federally Qualified HealthFederal legislation clarified that Federally Qualified HealthFederal legislation clarified that Federally Qualified HealthFederal legislation clarified that Federally Qualified HealthCenters (FQHCs) may contract with private dentists:Centers (FQHCs) may contract with private dentists:
Expands FQHC’s ability to meet community need while Expands FQHC’s ability to meet community need while engaging private dentistsengaging private dentistsPatients remain FQHC patients, private dentists can see Patients remain FQHC patients, private dentists can see patients in their office and negotiate payment contract with patients in their office and negotiate payment contract with FQHCFQHCFQHCFQHCEndorsed by the American Dental Association (ADA) and Endorsed by the American Dental Association (ADA) and the National Association of Community Health Centers the National Association of Community Health Centers (NACHC).(NACHC).
See: See: http://www.cdhp.org/resource/FQHC_Handbookhttp://www.cdhp.org/resource/FQHC_Handbook 2121
Health ReformHealth Reform –– State ExchangesState ExchangesHealth Reform Health Reform State ExchangesState Exchanges
2010 Affordable Care Act (ACA), state insurance markets or2010 Affordable Care Act (ACA), state insurance markets or“Exchanges” are to be set“Exchanges” are to be set--up by 2014 up by 2014
In the establishment of Exchange(s) In the establishment of Exchange(s) –– decisions include decisions include requirements of insurers, consumer protections, essential benefitsrequirements of insurers, consumer protections, essential benefitsStates have discretion regarding participating plans, rates, and States have discretion regarding participating plans, rates, and –– to to some degree some degree –– available benefitsavailable benefitsPediatric dental care is mandated Essential Benefit Pediatric dental care is mandated Essential Benefit –– but much has but much has
t t b d t i d b t d i t ti d tt t b d t i d b t d i t ti d tyet to be determined about design, consumer protections and outyet to be determined about design, consumer protections and out--ofof--pocket expensespocket expenses
More information:More information: http://cdhp org/cdhp healthcare reform centerhttp://cdhp org/cdhp healthcare reform centerMore information: More information: http://cdhp.org/cdhp_healthcare_reform_centerhttp://cdhp.org/cdhp_healthcare_reform_center
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Information AvailableInformation AvailableInformation AvailableInformation Available
Children’s Dental Health ProjectChildren’s Dental Health ProjectChildren s Dental Health ProjectChildren s Dental Health Projectwww.cdhp.orgwww.cdhp.org
National Maternal and Child Oral Health Policy CenterNational Maternal and Child Oral Health Policy Centerwww.nmcohpc.orgwww.nmcohpc.org
Fluoride Legislative User Information Database (FLUID)Fluoride Legislative User Information Database (FLUID)fl idlfl idlwww.fluidlaw.orgwww.fluidlaw.org
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Oral Health and the Affordable Care Act
Rebecca AlderferRebecca AlderferManager, Strategic InitiativesPew Center on the States
Agenda
1 Brief Overview of the Pew Children’s Dental Campaign1. Brief Overview of the Pew Children’s Dental Campaign
2. Dental Coverage under Affordable Care Act
3. Programs with Direct Funding
4. Authorized Discretionary (Annual) Oral Health Programs
5. Commissions and Federal Initiatives (for information only)
6 Summary and Questions6. Summary and Questions.
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About The Pew Center on the States
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Our WorkOur Work• Fiscal Health
• Government Performance• Government Performance
• Election Initiatives
• Partnership for America’s Economic Success• Partnership for America s Economic Success
• Pew Children’s Dental Campaign
• Pew Home Visiting CampaignPew Home Visiting Campaign
• Pre-K Now
• Public Safety Performance ProjectPublic Safety Performance Project
• Results First
• Stateline
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Stateline
Pew’s Children’s Dental Campaign
Mission:
T t li i th t illTo promote policies that will help millions of children maintain healthy teeth, and come to school ready to learncome to school ready to learn.
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Focusing on Three Policy Areas
Prevention
• Community water fluoridation campaigns (CA, AR, MS)
• National messaging & strategy development
Funding for care
• Advocating for federal funding and support for oral health programssupport for oral health programs
• Medicaid reimbursement for fluoride varnish by MDs and RNs
Dental Workforce
• Ensuring adequate workforce to care for children (MN, CA, ME, NH)
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• Research on economics of new models
Pew Campaign Federal Agenda: Supporting State Policy
• Increasing federal financial investments in oral health prevention and care; including workforce
• Improving federal Medicaid, Community Health Centers, and grant program policies and criteria to ease barriers to care
• Showcasing state models for pragmatic, cost-effective reform and recruit national champions
• Serving as a resource and liaison to federal policymakers and state campaign advocates
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Dental Coverage in theDental Coverage in the Affordable Care Act
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State Health (Insurance) ExchangesState Health (Insurance) ExchangesEssential Health Benefits RequirementsA di t i d t l b fit i i d i th ti l b fitA pediatric dental benefit is required in the essential benefits package of the new State exchanges
Timing: January 1, 2014
Agency: Secretary of Health and Human Services
Authorization: New
• Pediatric dental benefit is yet undefined • Secretary is charged with defining the scope of the
benefits. The Institute of Medicine is running a process to gather input.
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Medicaid ExpansionMedicaid ExpansionMedicaid Expansion for the Lowest Income PopulationsMandates that states set their Medicaid income eligibility cap no g y plower than 133% of FPL. Coverage extended to all citizens meeting the income eligibility standard (childless adults)
Timing: January 1, 2014
Agency: Secretary of Health and Human Services
Authorization: New
• Raises eligibility for 6-19 year olds in 20 states: AL, AZ,Raises eligibility for 6 19 year olds in 20 states: AL, AZ, CA, CO, DE, FL, GA, KS, MS, NV, NY, NC, ND, OR, PA, TN, TX, UT, WV, WY
• Option for states to adopt this expansion before 2014
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Option for states to adopt this expansion before 2014
Funding for CHIP
Extends CHIP through FY 2015Extends CHIP through FY 2015Funding for the Children’s Health Insurance Program (CHIP) is extended through fiscal year 2015, effective immediately, and the program is authorized to continue through 2019.program is authorized to continue through 2019.
Timing: Funded March 23, 2010 - FY 2015Authorized to continue through 2019Authorized to continue through 201923% FMAP increase beginning FY 2016
Authorization: New/amends existing
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Summary of Dental Coverage
• ‘Almost’ universal dental coverage for childrenAlmost universal dental coverage for children– Paired with the requirement to carry health insurance– Estimated 5.3 million additional children will obtain dental
coveragecoverage
• Adult dental coverage continues to be optional under MedicaidMedicaid
– States continue to drop adult dental benefits due to budget constraints
• Adult dental coverage not included as part of the essential benefits package to be offered in the state exchanges.
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Programs with Direct Funding in ACA
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Supporting the Dental Safety NetCommunity Health Centers FundAppropriated $11 billion to the CHC program
• $9.5 billion to expand operational capacity and enhance health services, including oral health services
• $1.5 billion for construction and renovation of community health centers
National Health Service Corps FundAppropriated $1.5 billion to the National Health Service Corps
• Programmatic improvements and placement of estimated 15,000 primary care providers in shortage areas
Grants for the Establishment of School-Based Health CentersAppropriated $200 million
• Restricted to expenditures for facilities; cannot be used for operations
• HRSA recently announced approx. $50 million for estimated 1,000
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y ppSBHC grants in FY 2010
Source; National Association of Community Health Centers. “Community Health Centers and Health Reform: Summary of Key Health Center Provisions.” 2010. http://www.nachc.com/client/Summary%20of%20Final%20Health%20Reform%20Package.pdf (accessed May 19, 2010)
P ti d P bli H lth F dPrevention and Public Health Fund: FY2010-FY 2011 Allocations
• FY 2010 = $500 million allocation– $250 million to support training for and expansion of the primary
care workforce– $250 million for prevention
• FY 2011 = $750 million allocation
$298 illi t t it ti– $298 million to support community prevention
– $182 million to support clinical prevention
$137 million to support public health infrastructure and training– $137 million to support public health infrastructure and training
– $133 million to support research and tracking
• FY 2012 = $1 billion allocation (proposed)
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FY 2012 $1 billion allocation (proposed)
Source: U.S. Department of Health & Human Services. “Fact Sheet: Creating Jobs and Increasing the Number of Primary Care Providers.” July 8, 2010. http://www.healthreform.gov/newsroom/primarycareworkforce.html (accessed 7/8/10).Source: U.S. Department of Health & Human Services. “Affordable Care Act: Laying the Foundation for Prevention.” July 8, 2010. http://www.healthreform.gov/newsroom/acaprevention.html (accessed 7/8/10).
Supporting Public Insurance
Medicaid and CHIP Payment and Access Commission (MACPAC) -- Assessment of Policies Affecting All Medicaid B fi i iBeneficiariesExpands duties originally set out in the Children’s Health Insurance Reauthorization. Including ‘how factors affecting
dit d t th d l i bl b fi i i texpenditures and payment methodologies enable beneficiaries to obtain services, affect provider supply, and affect providers that serve a disproportionate share of low-income and other vulnerable populationsvulnerable populations.
Timing: FY 2010
Funding: $11 million for FY 2010
Authorization: Amends existing authorization, members already
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Authorization: Amends existing authorization, members already named
Authorized DiscretionaryAuthorized Discretionary (Annual)( )
Oral Health Programsi ACAin ACA
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Supporting Public Health• 5-year national, public education campaign focused on oral healthcare
prevention and education
• Demonstration grants to show the effectiveness of research-based gdental caries disease management activities
• Expanded oral health surveillance collections; national and stateExpanded oral health surveillance collections; national and state specific
• Expanded cooperative agreements to improve oral health infrastructure• Expanded cooperative agreements to improve oral health infrastructure
• Requirement that all states, territories and Indian tribes receive grants f h l b d d t l l t
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for school-based dental sealant programs
Supporting the Dental WorkforceDemonstrations and evaluation of alternative dental health care providersGrant funds are to be used to train or employ new types of dental providers in order to increase access to dental health care services in rural and other underserved communities.
Timing: 5-year program to begin no later than March 23 2012 funding can start inMarch 23, 2012, funding can start in March 2011
Agency: Secretary of Health and Human Services; Contract with the Institute of Medicine for program evaluation
Funding: Authorized; each grant will be at least $4 million to be distributed over the life ofFunding: Authorized; each grant will be at least $4 million, to be distributed over the life of the 5-year project – total of at least $60 million
Authorization: New, requires compliance with state law
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Supporting the Dental Workforce
Expanded dental training programsThe Secretary may make grants to or enter into contracts with a
pp g
The Secretary may make grants to, or enter into contracts with, a school of dentistry, public or nonprofit private hospital, or a public or private nonprofit entity to establish and improve training programs, provide student financial assistance, provide technical assistance and
t f lt l tsupport faculty loan repayment programs.
Timing: FY 2010 - FY 2015
Agency: Secretary of Health and Human Services
Funding: FY 2010: Authorized to be appropriated $30 millionFunding: FY 2010: Authorized to be appropriated $30 millionFY 2011-FY 2015: such sums as necessary
Authorization: Amends Title VII of the Public Health Service Act
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Authorization: Amends Title VII of the Public Health Service Act
Supporting the Dental Safety NetSupporting the Dental Safety NetSchool-Based Health Center GrantsRequired basic services include “referrals to, and follow-up for, specialty care and oral health services”
Timing: FY 2010-FY 2014g
Agency: Secretary of Health and HumanServices, Bureau of Primary yHealthcare
Funding: Authorized such sums as necessaryg y• Covers operation and equipment costs for existing facilities
Authorization: Amends Title III of the Public Health Service Act
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(42 U.S.C. 280h et seq.)
Federal InitiativesFederal Initiatives(For Information Only)
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Department of Health and Human Services -Oral Health Initiative 2010
This initiative utilizes a systems-approach to create and finance programs to:• Emphasize oral health promotion/disease
prevention• Increase access to care• Enhance oral health workforce• Eliminate oral health disparities
http://www.hrsa.gov/publichealth/clinical/oralhealth/hhsinitiative.html
46Source: U.S Department of Health and Human Services, Health Resources and Services Administration. 2010. “HHS Oral Health Initiative.” http://www.hrsa.gov/publichealth/clinical/oralhealth/hhsinitiative.html (accessed May 21, 2010)
HRSA and Institute of Medicine Projects
Oral Health Access to ServicesP E i i th t ff t d dPurpose: Examine issues that affect underserved
populations that are most vulnerable to oral disease and the role of public and private safety net providers with a specific focus onsafety net providers, with a specific focus on women and children.
A O l H lth I iti tiAn Oral Health InitiativePurpose: Explore ways to increase public awareness of the relationship and importance of
d l h lth t d h i l h lth tgood oral health to good physical health; promote prevention and improve oral health literacy to health providers and the public; and recommend ways to improve access to oral health care
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ways to improve access to oral health care.
Source: Institute of Medicine of the National Academies. Activities, Consensus Study. Last Updated Feb 25, 2010. “Oral Health Access to Services.” http://iom.edu/Activities/HealthServices/OralHealthAccess.aspx (accessed 7/12/10)
Summary and QuestionsSummary and Questions
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Summary • New insurance coverage and new resources
– Estimate 5.3 million children could gain dental coverageE pansion of Comm nit Health Center operational and– Expansion of Community Health Center operational and facilities grants
– Authorized programs supporting prevention and workforce
• Action still needed: To secure federal investment in authorized dental programs
49
Rebecca Alderfer, [email protected] 540 6349202-540-6349
Bob Russell, DDS, MPHINSIDE I‐SMILE™: 2010Bob Russell, DDS, MPHDental Director, Iowa Department of Public Health
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Multiple Locations: Multiple Locations: private practices, private practices,
clinics, public health clinics, public health iiMultiple Multiple
Providers: Providers: dentists, dentists, hygienistshygienists
settingssettingsIntegrated Integrated services: services:
prevention, care prevention, care hygienists, hygienists, nurses, nurses,
physiciansphysicians
coordination, coordination, treatment, treatment, educationeducation
53
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55% more Medicaid eligible (ME) children f dreceive care from dentists
58% more ME children receive preventive pcare from dentists
Title V (Maternal and Child HealthTitle V (Maternal and Child Health Services Block Grant) staff provide care to 3x as many ME children than before3x as many ME children than before
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One in ten children at WIC (6 months‐4 yrs) have untreated decayyrs) have untreated decay
One in five children ages 3‐4 at WIC have guntreated decay
f h ld d b f17% of children screened before kindergarten have a dental treatment needneed
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D ti tDentists:
Less than 1% of ME children received an exam b f th f 1before the age of 1
10% received a service from a dentist before turning 2turning 2
Title V/Public Health:
6% of ME children received a screening before the age of 1
15% received a screening and/or fluoride before the age of 2
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639 children received fluoride varnish from medical practitioners in 2010medical practitioners in 2010 (up from 13 in 2005)
School dental screening requirement isSchool dental screening requirement is increasing the number of children who are ready to learny
I‐Smile™ Coordinators are successful in building partnerships and local bu d g pa e s ps a d ocainfrastructure
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Dental Screening gRequirement
Created by Iowa legislature in 2007;Created by Iowa legislature in 2007; implemented 2008-2009 school year
Overall goal: Improve the oral health ofOverall goal: Improve the oral health of Iowa’s children
Who is included?59 Who is included?
• Any student seeking enrollment in kindergarten or 9th grade in an Iowa public or accredited non-public elementary or high school
• Exemptions allowed for:• Religious reasonsReligious reasons• Financial hardship
Who can provide screening?60 Who can provide screening?
Ki d t• Kindergarten– Dentist or dental hygienist– Physician, physician assistant,
registered nurse or nurse practitionerg p• 9th grade
Dentist or dental hygienist– Dentist or dental hygienist
SCHOOL SCREENING RESULTS61 SCHOOL SCREENING RESULTS
2008 2009: 57% of students with valid certificate2008-2009: 57% of students with valid certificate
2009-2010: 70% of students with valid certificate No
problemsRequireCare
RequireUrgent Care
DDS RDH MD/DO PA RN/ARNP
2008‐2009
84.1% 12.7% 2.3% 67.7% 25.5% 0.4% 0.1% 4.3%
2009‐2010
83.7% 13.6% 2.7% 71.3% 22.9% 0.9% 0.2% 4.6%
I‐Smile™: The Future62 I Smile : The Future
P bli i hiPublic‐private partnerships
Link with primary health care (I‐Smile™ risk assessment, dental diagnosis codes, electronic health records)dental diagnosis codes, electronic health records)
Improvements to Medicaid
Workforce considerationsWorkforce considerations
Public education and oral health promotion
Outreach to dentists and physicians about the oral health needs of very young and at‐risk children
More gap‐filling services within public health to preventMore gap filling services within public health to prevent disease
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Bob Russell, DDS, MPHIowa Department of Public Health
Bureau of Oral and Health Delivery Systems1 866 528 40201‐866‐528‐4020
Additional ResourcesAdditional ResourcesNCSL's States Implement Health Reform: Oral Health brief
http://www.ncsl.org/?tabid=22477
NCSL Children’s Oral Health pagehtt // l /?t bid 14495http://www.ncsl.org/?tabid=14495
Pew Children’s Dental Campaignhttp://www pewcenteronthestates org/initiatives detail aspx?initiatihttp://www.pewcenteronthestates.org/initiatives_detail.aspx?initiati
veID=42360
Children’s Dental Health Projectjhttp://www.cdhp.org/
Health and Human Services: Center for Disease Controlhttp://www.cdc.gov/oralhealth/
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webinar.
For additional information, please contactTara Lubin: tara lubin@ncsl org orTara Lubin: [email protected] or
Jen Wheeler: [email protected]
Thank you!