Recent developments in access to dental care in Ohio
Access to dental care is a topic that receives a great deal of attention here in Ohio and across America. Reducing barriers to dental care is as important now as ever since studies continue to show that good oral health is critical to good overall health.
Some advocate for a two-tiered system where those who have private insurance or otherwise can afford care get treated by a dentist, while low-income individuals would be shuttled into lesser trained providers, including dental therapists.
The ODA rejects the two-tiered system, treating low income Ohioans as second-class citizens. Instead, the ODA continues to develop solutions that ensure all Ohioans have access to the highest quality dental care.
Dentist volunteerism and access to care programs
The ODA administers several programs through which ODA member dentists provide direct care to low-income Ohioans. The Dental OPTIONS program is a public-private partnership between the ODA and the Ohio Department of Health through which dentists provide free or reduced fee dentistry to low-income Ohioans. Nearly 1,000 dentists participate in the program providing over $1 million in donated dental care annually to uninsured Ohioans.
Similarly, ODA’s Give Kids A Smile program continues to provide opportunities for thousands of underserved Ohio children to receive dental care. In fact, this year, Give Kids A Smile events are being held in more than 75 sites across Ohio where Ohio’s dentists will donate a total of nearly $1 million in donated care to Ohio’s school children.
Ohio’s dental schools also provide much needed care to the underserved. The Ohio State University College of Dentistry administers the OHIO Project, whereby dental school faculty and senior dental students provide dental care to under-served populations in 27 clinic sites throughout Ohio.
Also, the OSU College of Dentistry administers the Dental H.O.M.E. (Health Outreach Mobile Experience) Coach, which enables faculty-supervised dental students to provide basic dental treatment to approximately 2,000 children annually at Columbus City Schools during regular classroom hours.
Case Western Reserve University School of Dental Medicine administers its Healthy Smiles program, a school-based sealant program whereby more than 280 dental school faculty and students visit 100 Cleveland-area grade schools annually to provide free exams and sealants. Since the program’s inception in 2001, Healthy Smiles has provided dental care to more than 87,000 children in the Cleveland Metropolitan School District and more than 270,000 children in the district have received oral health education.
Case Western also has a new Lifelong Smiles mobile unit where dental students, under the supervision of faculty, provide oral exams, digital X-rays, cleanings, fillings, dentures, extractions and cancer screenings on the mobile dental unit for many patients who haven’t visited a dentist in years. The van is driven and parked outside Cleveland-area nursing homes and assisted-living facilities for residents to come aboard. In addition, two portable dental chairs are set up inside the facilities for those patients who cannot get on the van. The Lifelong Smiles van is part of Case’s new Geriatric Dental Program, focusing on the oral health needs of older patients.
In addition to the dental schools’ outreach programs, the ODA has developed the Smiles for Seniors program, which is designed to improve awareness of the unique oral health issues the elderly may experience. The ODA has distributed more than 1,000 program modules, including CD-ROMs with video content and printed materials to long-term care facilities, assisted living programs and senior centers to educate care-givers on maintaining the daily oral hygiene of the residents. Dental associations and health care facilities in 26 other states have now requested and received permission to utilize and replicate the Smiles for Seniors program as well.
According to a survey conducted by an independent survey research firm, the typical ODA member annually provides more than $13,000 worth of free dental services to the under-served. That means that ODA members provide more than $40 million in free services to needy populations every year. That is just dentists doing what they do every day – taking care of the oral health of families in their communities who are in need.
The ODA has made improving access to dental care a priority within its advocacy efforts at the Statehouse, including working to reform the dental Medicaid program, creating, funding and expanding loan repayment programs, providing civil immunity for volunteer dental care, allowing dentists to secure continuing education credits by providing free care at ODA-sponsored access to care programs, etc.
For years, the ODA has been the lead advocate in trying to improve the dental Medicaid program in Ohio. The ODA worked to restore dental Medicaid coverage for adults in the early 2000s. In recent years, the ODA has worked to educate policymakers on the fact that Ohio’s Medicaid reimbursements to dentists are some of the lowest in the nation after 15 years of neglect from 2000 to 2015. As a result of those efforts, for fiscal years 2016-17, the state budget includes a small increase in funding for the dental Medicaid program, most of which is targeted to 52 rural counties. This is a positive step in the right direction, but more needs to be done.
Because of the 15 years of neglect between 2000 and 2015, Ohio’s Medicaid program reimburses on average at about 40 percent of dentists’ regular fees for most basic dental services. This places Ohio in the bottom 10 states in terms of dental Medicaid reimbursement levels nationally. Because of the nature of providing dental care, including the cost of equipment and supplies, the typical dental office has a 60 – 65 percent overhead ratio. This means that most dentists don’t even break even when treating Medicaid patients. This is especially unfortunate since we know states that have increased dental Medicaid reimbursements to levels closer to market rates have significantly improved access to dental care.
For example, Connecticut raised their reimbursements to the 70th percentile of dentists’ regular fees and now utilization rates for Medicaid reimbursements are the same as those patients with private insurance. One recent study that examined the impact of dental Medicaid fee increases in Connecticut, Texas and Maryland concluded that “increasing Medicaid dental fees closer to private insurance fee levels has a significant impact on dental care utilization and unmet dental need among Medicaid-eligible children.”
House Bill 463 – Ohio’s Dental Care Modernization Act
For nearly a decade, Ohio dentists have fully funded the Ohio Dentist Loan Repayment Program, which has incentivized dozens of Ohio dentists to relocate to underserved settings and provide care to Medicaid eligible and other low income Ohioans. This program achieves two significant ODA objectives: (1) assisting young dentists with their debt load (the typical dental student graduates with close to $250,000 in debt) and (2) incentivizing dentists to provide care in underserved communities.
Because of legislation that became effective just last year – House Bill 463 from the 130th General Assembly – the capacity of the Ohio Dentist Loan Repayment Program will double, allowing more dentists to participate in this innovative program that is making a difference in underserved communities and in clinics that are now better able to attract dentists because of the loan repayment. It is truly impressive that this impactful program is entirely funded by the dentists of Ohio.
This legislation also created changes to the laws related to Ohio’s dental auxiliaries, allowing dental hygienists to apply fluoride varnish and conduct oral health education and nutritional guidance in any setting without the on-site supervision of a dentist. The law also expands the opportunities for dental hygienists, expanded function dental auxiliaries and certified dental assistants to provide prevention services in various settings, including providing sealants in the schools.
This new law also expands the “Choose Ohio First” program, which currently provides scholarship opportunities to primary care physicians, to also include, for the first time, scholarships for dental students. This program is designed to ensure we keep Ohio’s best and brightest here in Ohio following graduation.
The new law also bolsters dental residency programs, which are important parts of the dental safety net in communities across Ohio, including Canton, Akron, Cleveland, Cincinnati, Findlay, Lima, Greenville, Middletown, etc., by creating an alternative pathway to licensure for residents who complete an accredited program. Graduates can now be licensed by the state without taking a regional clinical board examination by completing a residency program and satisfying all other licensure requirements.
There has been a tremendous growth in the number of dental residencies, Federally Qualified Health Centers (FQHCs) offering dental services and other dental clinics in Ohio over the last decade. Through programs like the Ohio Dentist Loan Repayment Program and alternative pathways for licensure, we have assisted these institutions in attracting more dentists to provide care for underserved patients.
The ODA and its Ohio partners have a long history of reducing barriers to care. We will continue to do that, not by sending Ohioans to lesser–trained providers, but by leveraging the resources we have to ensure Ohio’s most vulnerable patients have access to the highest quality of dental care.