Improving Access to Oral Healthcare: A Snapshot of State Initiatives

May 19, 2019 | Katrin Patterson

According to the American Dental Association (ADA), dental insurance coverage for children, adults, and seniors dropped by approximately 4-5 percent from 2010 to 2015. In 2016, dental care was found to have the highest level of cost barriers compared to other healthcare services, with 8.9 percent of the population reporting that they needed but did not obtain dental care in the past year due to cost.

Moreover, research has shown that poor oral health is associated with increased rates of chronic disease, including heart disease, diabetes, and respiratory infections. Public health investments that increase access to dental providers and oral health prevention programs could result in significant improvement in the health of Americans.

There are a number of states pursuing strategies to improve oral health outcomes, such as primary care and dental care integration, workforce innovations, and care delivery innovations. Several states are exploring ways to improve access to oral health services in their jurisdictions, methods that have either been enacted or introduced in the current legislative session.

Virginia has enacted a bill to allow dental hygienists to practice under the remote supervision of a dentist employed by the Virginia Department of Health. This bill also added mobile dentistry programs to the list of locations where a dental hygienist may practice under the remote supervision of a licensed dentist.

In North Carolina, a bill has been introduced to enhance Medicaid transformation by providing capitated contracts for the provision of dental services to Medicaid and the NC Health Choice recipients. In Maine, a bill would expand dental coverage to adult residents over 21 years of age who are eligible for Medicaid in Maine (also known as the MaineCare program). In addition, the bill would require dentists to adopt and implement policies to provide comprehensive dental services through charity care or financial assistance to those without access to comprehensive dental services under the MaineCare program or insurance.

In addition to these provisions, Maine has also introduced the Act to Improve Oral Health and Access to Dental Care for Maine Children. This bill represents a collaboration between the Department of Health and Human Services and the Maine Center for Disease Control and Prevention’s rural health and primary care division. The goal of the legislation is to expand preventive oral health services provided in schools through the rural health and primary care division’s oral health program to all schools, as well as provide funding for several staff positions to aid research, reporting, and overall program support in the expansion of dental services to schools.

In New Hampshire, a bill has been introduced that would authorize the Medicaid managed care program to provide dental benefits to covered beneficiaries. Under the bill, the commissioner of the department of health and human services will convene a working group to develop a value-based dental benefit. In New Jersey, a bill has been introduced to establish the Office of the State Dental Director in the Department of Health. The state dental director would serve as a resource for oral health information and data, oral health evaluation, and will oversee all dental related programs, activities, and partnerships.

Elsewhere, New Mexico has introduced legislation that would establish a task force to study ways to expand access to Medicaid dental services for children. The study would investigate how to expand participation in dental care provider networks accepting Medicaid, how to increase the number of providers enrolled in Medicaid, reimbursement rates to Medicaid providers, how to increase access to oral health services for Medicaid patients, and ways to drive down the number and cost of Medicaid acute dental visits over time.

Finally, North Dakota recently changed an administrative rule (20-04-01-01) to allow dental hygienists to provide patients with oral hygiene treatment without a dental diagnosis by a dentist.

Across the country, states are pursuing a variety of way to increase access to dental services with the hope of improving the overall health of populations. ASTHO will continue to track these efforts and inform members as legislation develops.