NEW YORK STATE ORAL HEALTH INITIATIVE
CHILDREN’S ORAL HEALTH SUMMIT
October 29, 2001

A statement by Buddhi M. Shrestha, D.D.S., M.S., Ph.D., Chair, Rochester/New York State Oral Health CoalitionWHY IS THERE LIMITED ACCESS TO DENTAL CARE FOR MEDICAID AS WELL AS NON-MEDICAID CHILDREN?

1. Lack of dental insurance coverage and inadequate financial resources to pay for dental treatment for children among the non-Medicaid population are obvious ones.

2. Limited availability of dental care providers, e.g. many general dentists are unwilling to treat young children and very few dentists accept Medicaid patients.

3. Often low priority given to dental services for their children by underserved Medicaid as well as non-Medicaid “working poor” families, due to other competing family priorities.

As a result, children who cannot seek care on their own are the ones who suffer the most.

THE SOLUTION: SCHOOL-BASED DENTAL PROGRAMS

The best and proven way to enhance access to dental services for vulnerable children is through school-based dental programs. Rochester’s School-Based Dental Program can be used as a model.

  • Children receive high quality dental care from dentists and dental hygienists. The services include dental prophylaxis, fluoride, sealant and restorative treatments. The hygienist also provides dental screening and referral services, as well as dental education for children and their parents.
  • Appropriate preventive and basic dental treatment is provided at the school in the shortest amount of time and with minimum loss of class time for participating children. All necessary treatments are completed within one month.
  • Parents are not required to be present or arrange appointments, lose time from work, or transporting children to and from a dentist’s office.
  • Children receive follow-up dental care each year at school

A recent report (Buddhi Shrestha and co-workers, J Dent Res 79: 503, 2000) demonstrated that school-based dental programs have the greatest potential for enhancing access to preventive and primary dental care for Medicaid and other underserved child populations. Furthermore, as identified by Surgeon General’s report (2000), school-based dental programs may also be the best way to reduce the oral health disparity that currently exists among the children of poverty.

BARRIERS TO SCHOOL-BASED ORAL HEALTH PROGRAMS

The New York State Health Department’s “Communities Working Together for a Healthier New York”, September 1996 clearly recognizes such barriers and recommends for “eliminating administrative barriers for providers to increase the availability of dental services, especially school-based dental services”

Current regulatory barriers to school-based dental services in New York State.include;

  • Restrictions on provision of dental treatment services at “Part-time School Dental Clinics” during school-hours.

According to NYS Department of Health Rules and Regulations, Title 10, Part 700.2, Section 22 a part-time clinic site shall mean an ambulatory care program site operated less than 60 hours per month (as determined by the aggregate hours of program site operation) by a general hospital or a diagnostic or treatment center which is approved to operate part-time clinics. A part-time clinic site is a site other than the primary delivery site(s) listed on the primary facility’s operating certificate; PROVIDED, HOWEVER, THAT ANY HEALTH CARE SERVICES PROVIDED IN ELEMENTARY OR SECONDARY SCHOOLS TO STUDENTS DURING REGULAR SCHOOL HOURS SHALL NOT QUALIFY AS PART-TIME CLINIC SITES UNDER THIS TITLE.

  • Current NYS regulations allow only NYSDOH’s School Health Program funded school-base health centers to have dental services as an “optional service”. There is no provision for establishing a “stand-alone” school-based oral health clinic.

Therefore, it is important that these and other existing regulatory/administrative barriers need to be removed.

OTHER ISSUES PERTAINING TO ACCESS AND UTILIZATION OF DENTAL CARE SERVICES AMONG THE UNDERSERVED CHILD POPULATION

The recent expansion of Child Health Plus (CHP) benefits to include dental care should significantly enhance access to much needed preventive and primary dental care for children of many working poor families in the State of New York. However, it is important to recognize that providing access to dental care by itself will do no good unless the insured child is able to “utilize” the available dental care services. Thus “Access – Utilization = No Access”.

Federal law requires that states provide “Early and Periodic Screening, Diagnostic and Treatment” (EPSDT) for dental and other health services to eligible children from birth through age 20. The percentage of Medicaid-eligible children who received EPSDT preventive dental services in New York State in 1993 was about 18% (ranked 30th in the nation). This means that 82% the Medicaid children having the eligibility for full dental benefits did not receive care even at a basic level, one can imagine how much chance a needy child of non-Medicaid working-poor parents would have in receiving simple, cost-effective preventive and primary dental care.

It is imperative that we develop more effective way to deliver preventive and primary dental care services to low-income children. Otherwise the Child Health Plus dental program will meet with results similar to Medicaid.

ALLOCATION OF STATE/FEDERAL FUNDING EARMARKED FOR DENTISTRY

One way to develop an effective oral health care delivery system is to allocate a reasonable portion of available State/Federal healthcare funding, earmarked for oral health care services, instead of single allocation for both medical and dental services. Even though a physician and a dentist deliver their respective services to the same patient, health outcomes as well as cost-effectiveness of their services may differ.

Thus, the provision of state/federal funding earmarked for dentistry would not only allow cost-effective management of dental services with measurable health outcomes but also provide an opportunity to demonstrate that improved oral health through early prevention and intervention can reduce the cost of dental care, in the future.

THE VALUE OF PREVENTIVE AND PRIMARY DENTAL CARE SERVICES

FOR THE FUTURE OF OUR CHILDREN

Investments by Federal, State and Local Government, as well as community funding resources in children’s preventive and primary dental health care are prudent, economical and predictably produce positive health outcomes. Rochester’s Smilemobile Program, a partnership among University of Rochester Eastman Dental Center, Rochester City School District and Monroe County Health Department, has a proven track record of many years for such accomplishments. Similar school-based dental programs in New York State as well as nationwide, have also shown such benefits.

Unfortunately, children’s dental health issues frequently seem to get lost in the “big political arena” of other health care issues and often get short-changed in allocation of resources.

THEREFORE, IN LIGHT OF THESE FACTS AND OTHERS, THE ROCHESTER ORAL HEALTH COALITION MAKE THE FOLLOWING RECOMMENDATIONS:

  1. By 2003, NYSDOH allocate a fair and adequate portion of federal and state funding resources, including MCH Block Grant funding earmarked for children’s oral health.
  2. By 2002, revise the appropriate sections of State Education Law, such as A7 414, to permit the operation of dental programs in schools, and clarify both the Education Department and Health Department regulations governing the operation of dental programs in schools, Head-Start Centers, and other community health care settings.
  3. By 2003, provide funds to establish mini-pediatric dentistry residency programs for training practicing dentists and to strengthen pediatric dentistry training component in General Practice Residency Programs for improving access to care for young children.
  4. By 2002, expand existing scholarships and loan forgiveness programs to include dentists and dental hygienists and also provide incentives such as low or no-interest loan opportunities for buying homes or dental equipment, for dentists to establish dental practices in rural and designated health manpower shortage areas.
  5. By 2005, develop an advanced clinical training program for RDHs to become “Registered Dental Hygienist Practitioners” (RDHP) for allowing them to perform expanded procedures such as temporary and atraumatic restorations or minor Class I / Class V restorations for enamel caries, etc. Such practices would allow more time for dentists to do advanced procedures in an efficient and cost-effective manner, and would particularly help dental practices that are located in rural and dental health professional shortage areas.
  6. By 2003, allow qualified dentists and dental hygienists trained in foreign countries, who received advance training in the United States, to practice in federally designated health manpower shortage areas by amending Chapter 109 of the Laws of 2001 that authorize alien physicians to practice in a medically underserved area for 3 years with an additional extension to 6 years to secure citizenship.

Submitted for consideration by the summit workgroups.

October 29, 2001

Buddhi M. Shrestha, D.D.S., M.S., Ph.D.Chair, Rochester/New York State Oral Health Coalition
Rochester Primary Care Network
Associate Professor of Community and Pediatric Dentistry
University of Rochester Eastman Dental Center