Poor oral health is a health disparity for low-income people and people with disabilities. Dental illnesses significantly increase the risk of chronic health conditions, result in missed days of work and school, and negatively affect employability. According to an American Dental Association survey, approximately 33% of Americans who have income lower than 138% of federal poverty level struggle to get employed because of the condition of their mouth and teeth.
Poor oral health can easily compound the effects of preexisting conditions and aggravate already fragile socioeconomic well-being, both at the individual and population levels. However, oral health care delivery and services can be improved through innovations in programming, financing, and workforce training. Using the population health framework, states can make significant strides towards improving their population's overall health by improving dental care access and delivery.
Below are some examples of public health policy interventions underway in the U.S in various states to address this important health disparity.
Impact of Medicaid on Access to Oral Health Services
State Medicaid programs including AHCCCS are mandated to provide comprehensive dental coverage for Medicaid-enrolled kids - but aren’t required to offer dental coverage to Medicaid‐enrolled adults. Nationally there’s an uneven patchwork of dental care coverage that impacts access to dental services.
Arizona provides emergency dental services to all enrolled adults up to a $1,000 annual cap. But coverage alone isn’t enough to actually get care. Many dental providers don’t accept Medicaid coverage and nearly 49 million people are living in dental health professional shortage areas (HPSAs) across the country (HPSAs are geographic regions, populations, or facilities that are lacking sufficient healthcare providers).
Many states have used Medicaid waivers demonstrations to improve dental care. For example, California developed a Dental Transformation Initiative to increase dental care access and address the specific oral health needs of children by providing incentive payments to dental providers for achieving state-defined targets. Here are some examples that are being implemented across the country:
Alignment with Population Specific Services
Oral health programs or pilots can also be aligned with current services provided by the state for increasing access to oral health services for specific populations. For example, New Hampshire created a pilot program held at local WIC sites to integrate preventative oral health care for low-income women and children into existing safety net programs. It included a weekly dental clinic at each WIC site at which dental hygienists and dental assistants provided preventative care and referred participants to local Medicaid-enrolled dental providers for follow-up care.
Last legislative session Arizona lawmakers approved a new class of dental professionals called Dental Therapists who, over time, will be about to meet some of the workforce demands in Arizona’s rural and underserved areas. The Board of Dental Examiners still needs to develop the Administrative Code (Rules), but dental therapists will be practicing on the horizon, providing a potentially important access point in rural and other underserved areas.
Care Delivery Innovations
Advances in telehealth can also be promising avenues for improving access to oral health care too. For example, Alaska used telehealth to address its oral health needs. Given the lack of access to oral healthcare that affects their rural residents, they established the practice of mid-level oral health providers known as dental health aide therapists. Telehealth (specifically live videoconferencing) allows these aides to connect with supervising dentists in hub locations who are then able to provide professional oversight and supervision virtually.