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Mission“To improve the well being of children by

effecting positive changes in public policies, priorities, and programs”

• Early Learning Now: Early Learning Campaign

• End Childhood Hunger: Hunger and Nutrition Campaign

• Cover All Kids: Healthcare Campaign– Oral Health Access

• Convene Washington Dental Access Campaign

Children's Alliance

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Workforce as part of the solution

– Racial and ethnic minorities, including immigrants and non-English speakers

– Children, especially those who are young

– Pregnant women

– People with special needs

– Older adults

– Individuals living in rural and urban underserved areas

– Uninsured and publicly insured individuals

– Homeless individuals

– Populations of lower socioeconomic status

– Institutionalized

Population cohorts that display oral health disparities:

Institute of Medicine Oral Health Report

Institute of Medicine Oral Health Report

Recommendation •Congress and DHHS support demonstration models to increase access:

– New methods: nontraditional settings, non dental professionals, new types of dental professionals, telehealth

Recommendation•State legislatures should amend state practice acts to maximize access to care

– Technology supported and evidence-based supervision

Institute of Medicine: Improving access to care for vulnerable and underserved population (July, 2011)

Presentation - Health Care Reform: Where Do We Go From Here?Children's Dental Health Project: www.cdhp.org Publication Date: April, 2013

Oral Health in the ACA

Growing Momentum

The authors note dental therapists may be a more cost effective way to expand dental access than raising Medicaid rates for dentists. 

---The Effect of Medicaid Payment Rates on Access to Dental Care Among Children NBER working paper (July 2013)

   

Mid-level providers are in a position to provide much of the needed dental care at current Medicaid reimbursement rates. “…empowering mid-level providers is a common sense solution.”

----Senators Max Baucus and Charles Grassley issued a Joint Staff Report on dentistry and the Medicaid Program. (June 2013)

Growing Momentum

Growing Momentum

Latest systematic literature review: “…every study that directly compared the work of dental therapists with that of dentists found that they performed at least as well.” (2013)

Journal of the American Dental Association found mid-level dental providers deliver care, within their training, no different than dentists. Study found groups cared for by dental teams using dental therapists had higher rates of untreated cavities than those dentists practicing alone. (January 2013)

Community Catalyst report: Economic Viability of Dental Therapists (May 2013), Dr. Francis Kim  

The report determined that midlevel dental providers currently practicing in Alaska and Minnesota cost their employers 27 and 29 percent respectively of the revenue they generate. 

Growing Momentum

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Growing Momentum

Growing Momentum

2010 – Children’s Alliance learned of a draft language by WSDA, WSDHA and Rep. Eileen Cody.

– CA worked with community partners to insert DHAT model

2011 – House Bill 1310

– Hearing in House Committee. Chair held bill in committee.

2012 – House Bill 2226 / Senate Bill 6126

– House and Senate Hearings. Passed out of Senate committee.

– Fall of 2012 WSDA passed “dental auxiliary” in their HOD changing scope and excluding off-site supervision.

– WA Dental Access Campaign encouraged further dialogue.

2013 – House had 2 bills / Senate had structural upheaval

– House Bill 1516 / Senate Bill 5433 – WDAC supported

– House Bill 1514 – dental association’s proposal – WDAC and WSDA opposed.

– Primary focus of legislative community: restoration of adult dental

Washington State

Medicaid Eligible January 1, 2014

Reinstatement of Medicaid Adult Dental

Newly Eligible Adults up to 133% FPL

Over 700,000*

280,000450,000

It was pain that she’s never experienced and I hope she never has to again.

-- 8 year old Ashley’s Mom

If it was a choice of me getting a cavity filled or my son getting shoes for school, my son got shoes.

-- Kim, Vancouver

Providing oral health care for my family is often too costly for me. It has resulted in us having to choose extractions because we cannot afford restoration.

-- Pat, Tacoma

I can only chew on one side of my mouth. I go to the emergency room when things get too painful.

-- Brenda, Snohomish

My dental problems caused me to have chronic sore throats and on-going headaches….As of now, it is painful to chew…If I want to eat meat, I must pull the meat with my fingers.

-- Lori, Hoquiam

People suffer terribly with dental pain and often cannot afford routine dental care to prevent more serious problems.

-- Betsy, Bellingham

There is only one dentist who takes Medicaid in the local community…only other option is to drive to Spokane which is just not realistic for struggling families.

-- Peggy, Newport

Need Across the State

Snohomish Co 2010 Needs Assessment: people rated dental care as a #1 unmet need.

A 2012 Clark Co. assessment of homeless veteran’s self-identified dental as #1 unmet need. Note, it was ranked over housing.

2010 Chelan/Douglas Community Assessment: “A public health nurse in our region compared our area’s adult dental care access to that of a third world country.”

Washington

“For the uninsured who come to the ER, affordable dental care is probably not an option.”

•Jan 2008–Jun 2009: 54,000 dental care visits costing $36.3 million

•Dental related issues are the #1 reason uninsured adults seek care Washington’s ERs.

•Medicaid recipients and the uninsured account for 2/3 of all ER dental visits

Washington State Hospital Association

Washington Dentists Participation in Medicaid

   FY 2009 FY 2010 FY 2011 FY 2012

Number of licensed dentists* 5,923 6,072 6,155 6,080

Number of dentists that serve Medicaid-enrollees** Based off claims payment data and age grouped 0-20

1,226 1,353 1,214 1,165

21% 22% 20% 19%

 Number of dentists that serve Medicaid-enrollees **Based off claims payment data and age grouped 21 +

1,111 1,210 997 626

19% 20% 16% 10%*WA State Department of Health**WA State Health Care Authority

• Duel Path that models Alaska and Minnesota– Retains 2 year Community/Technical College path without

requiring dental hygiene + extra year for scaling– Maximizes existing workforce through a path for

hygienists– Scope similar to the Minnesota

• Bill Sponsors & WA Dental Access Campaign– Maintain integrity of model (off-site supervision)– Protect scope of new provider– Settings / Population limitations—How does this work for

Tribes / Tribal Clinics?

Washington State

[i] This chart does not include post classroom clinical hours. Providers must practice on-site clinical hours with their supervising dentists before they are eligible for the dentist to send them off-site.

Teal = House Health & Wellness Committee

Tan = Senate Health Care Committee

Purple = Minority Leader

House Health Care

Rep. Matt Manweller (13th) Rep. Charles Ross (14th)

Rep. Shelly Short (7th)

Rep. Kevin Van de Wege

Rep. Dan Kristiansen (39th)Rep. Mike Hope (44th)

Tera Bianchi206.324.0340 X28

tera@childrensalliance.orgwww.childrensalliance.org