Oral health services sink their teeth into grants

With a growing recognition that tooth decay is the leading childhood condition among low-income, minority, and disabled populations (see State Health Watch, January 2003, p. 10) — five times more common than asthma — the Robert Wood Johnson Foundation in Princeton, NJ, has awarded three-year grants of up to $1 million each to six states to address the problem of inadequate access to oral health care services.

The program will be managed by the Center for Health Care Strategies (CHCS) of Lawrence-ville, NJ, and is intended to test a number of comprehensive, innovative approaches to improve access to oral health services for low-income, minority, and disabled populations served by Medicaid and the State Childrens Health Insurance Program (SCHIP) in Arizona, Oregon, Pennsylvania, Rhode Island, South Carolina, and Vermont. CHCS sources say the six states have already made significant improvements to oral health through Medicaid and SCHIP.

Developing strategies

The grants will help them develop more comprehensive strategies in at least two of these areas — further developing state financing and purchasing strategies; broadening provider networks; expanding the dental safety net; and enhancing consumer and provider education.

Anne Weiss, senior program officer of Robert Wood Johnson Foundation, says that many factors, such as a lack of awareness about the importance of oral health, combine to limit access to oral health services. "The selected grantees have proposed truly innovative projects to expand access to dental care and to organize, finance, and deliver health care services," she says.

A summary of the projects by state are listed below:

• Arizona. The state will establish a registered dental hygienist (RDH) program with the Arizona School of Health Sciences in partnership with three community colleges located within rural communities; build an RDH case management program for high-volume Medicaid oral health practices; develop a social marketing campaign to improve consumer awareness; design a curriculum for non-oral health practitioners emphasizing early detection and referral to the dentist; and train local dentists on issues relating to oral health care for people with disabilities.

• Oregon. The state proposed to expand and enhance preventive programs for low-income pregnant women and children up to 24 months of age in three demographically different communities. Partnerships will be developed with health plans, the private dental community, non-oral health practitioners, and federally qualified community health centers, including the Indian Health Service.

• Pennsylvania. Pennsylvania proposed to expand the provider network and dental safety net for low-income persons with special needs through a partnership with the Pennsylvania Dental Society, oral health training institutions, and the Primary Care Association to expand the numbers of expanded function dental assistants, which will give dentists additional time for patients. Also, a partnership with the state Department of Public Welfare and its contracted Medicaid managed care organizations will expand a successful multidiscipline safety net clinical model for efficient and comprehensive treatment for special needs patients from Philadelphia to another part of the state.

• Rhode Island. Rhode Island will develop a performance-based dental benefits manager contract to expand dental services to all of its Medicaid recipients. The state has partnered with the community-based Rhode Island Foundation to develop a freestanding pediatric dental residency, to provide grants for expansion of safety-net clinics, and to expand school-based health center RDHs.

• South Carolina. The state has collaborated with a broad base of stakeholders to develop these strategies: integrate oral health within medical homes and link with dental providers; train dentists to care for children and individuals with disabilities; coordinate with a faith-based project to provide case management and education to consumers; and expand the dental safety net in selected rural public health districts.

• Vermont. Vermont will expand oral health care education to consumers and providers; establish a primary care dental home for children in custody; link registered dental hygienist assessments of school children with community dentists; and collaborate with the Area Health Education Council to recruit and retain dentists.

[Contact the Center for Health Care Strategies at (609) 895-8101, and the Robert Wood Johnson Foundation at (888) 631-9989.]