Oral Health and the Affordable Care Act: State Roles · 5/17/2011 1 Oral Health and the Affordable...
Transcript of Oral Health and the Affordable Care Act: State Roles · 5/17/2011 1 Oral Health and the Affordable...
5/17/2011
1
Oral Health and the Affordable Care Act: State Roles
Presenting:Caswell Evans, Jr., DDS, MPH, Director, Associate Dean for Prevention and Public Health Sciences College of DentistryPrevention and Public Health Sciences, College of Dentistry,
University of Illinois at ChicagoRebecca Alderfer, MPP, Manager, Strategic Initiatives,
Pew Center on the StatesBobby D. Russell, DDS, MPH, Public Health Dental Director, Iowa
Moderated by Senator Jeremy Nordquist,Moderated by Senator Jeremy Nordquist, NCSL Health Committee Chair, Nebraska
This webinar is produced with generous support from the Pew Children’s Dental Campaign.
State Approaches and Policy State Approaches and Policy Options Regarding the Oral Options Regarding the Oral
H lth f ChildH lth f ChildHealth of ChildrenHealth of Children
May 18, 2011May 18, 2011
Caswell A. Evans, DDS, MPHCaswell A. Evans, DDS, MPHAssociate Dean for Prevention andAssociate Dean for Prevention andAssociate Dean for Prevention and Associate Dean for Prevention and
Public Health SciencesPublic Health Sciences
University of Illinois College of DentistryUniversity of Illinois College of Dentistry
22
5/17/2011
2
ChildrenChildrenChildrenChildren
For each child without medical insurance, For each child without medical insurance, ,,there are at least 2.6 children without dental there are at least 2.6 children without dental insuranceinsurance
Uninsured children are 2.5 times less likely Uninsured children are 2.5 times less likely than insured children to receive dental care than insured children to receive dental care
Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
33
Cleft lip/palate, one of the most Cleft lip/palate, one of the most
Cleft Lip/PalateCleft Lip/Palate
p p ,p p ,common birth defects, is common birth defects, is estimated to affect 1 out of 600 estimated to affect 1 out of 600 live births for whites and 1 out of live births for whites and 1 out of 1,850 live births for African 1,850 live births for African AmericansAmericans
Oral Health in America: A Report of the Surgeon General ~ DHHS 2000Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
44
5/17/2011
3
Dental caries (tooth decay) is the single most Dental caries (tooth decay) is the single most common chronic childhood diseasecommon chronic childhood disease---- 5 times5 timescommon chronic childhood diseasecommon chronic childhood disease 5 times 5 times more common than asthma and 7 times more more common than asthma and 7 times more common than hay fever common than hay fever
Poor children suffer twice as much dental Poor children suffer twice as much dental caries as their more affluent peers and theircaries as their more affluent peers and theircaries as their more affluent peers, and their caries as their more affluent peers, and their disease is more likely to be untreated disease is more likely to be untreated
Oral Health in America: A Report of the Surgeon General ~ DHHS 2000Oral Health in America: A Report of the Surgeon General ~ DHHS 200055
Dental caries is one of the most Dental caries is one of the most common diseases among 5common diseases among 5-- to 17to 17--
yearyear--oldsolds
Dental caries is one of the most Dental caries is one of the most common diseases among 5common diseases among 5-- to 17to 17--
yearyear--oldsolds
4 2
8.0
11.1
58.6
Chronic bronchitis
Hay fever
Asthma
Caries
Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
4.2
0 10 20 30 40 50 60 70
Chronic bronchitis
Percentage of children and adolescents ages 5 to 17
Note: Data include decayed or filled primary and/or decayed, filled, or missing permanent teeth. Asthma, chronic bronchitis, and hay fever based on report of household respondent about the sampled 5- to 17- year olds.Source: NCHS 1996
66
5/17/2011
4
67 4 70.580ary
r
Poor children 2 to 9 in each racial/ethnic group Poor children 2 to 9 in each racial/ethnic group have a higher percentage of untreatedhave a higher percentage of untreatedPrimary teeth than nonpoor childrenPrimary teeth than nonpoor children
Poor children 2 to 9 in each racial/ethnic group Poor children 2 to 9 in each racial/ethnic group have a higher percentage of untreatedhave a higher percentage of untreatedPrimary teeth than nonpoor childrenPrimary teeth than nonpoor children
67.4 70.557.256.1 56.9
37.3
01020304050607080
age
of d
ecay
ed p
rima
hat a
re u
ntre
ated
per
child
Non-Hispanic
Black
MexicanAmerican
Non-Hispanic
WhitePerc
enta
teet
h th
Poor Children Nonpoor ChildrenSource: NCHS, 1996
Oral Health in America: A Report of the Surgeon General ~ DHHS 2000
77
The “upside down” problem:
Children with most need have least care
88
5/17/2011
5
The challenge is to:The challenge is to:
1. Reduce disease burden
2. Improve access to quality care
The “fix” : Children with most need
get most care
quality care
99
Policy change may be necessary when what has Policy change may be necessary when what has been tried so far is not successful in reducing been tried so far is not successful in reducing
Why Policy MattersWhy Policy Matters
ggdisparities in oral health statusdisparities in oral health status
Policy change can shift funds and programming Policy change can shift funds and programming towards preventive measures and facilitate better towards preventive measures and facilitate better access to treatmentaccess to treatment
Policy change related to oral health has the Policy change related to oral health has the benefit of strong evidencebenefit of strong evidence--based solutionsbased solutions
1010
5/17/2011
6
A Few Trends in StatesA Few Trends in States
State mandates for dental screening for State mandates for dental screening for h lh l d hildd hildschoolschool--aged childrenaged children
Community Water Fluoridation Community Water Fluoridation SchoolSchool--based/linked dental sealant based/linked dental sealant programs programs Medicaid Reimbursement, Loan Medicaid Reimbursement, Loan ,,Repayment, & otherRepayment, & otherFederal / State: Federal / State: CHIP, FQHCs, & State CHIP, FQHCs, & State ExchangesExchanges
1111
State Laws State Laws –– Dental “Screening”Dental “Screening”
State laws that require certification of an oral health assessment as a State laws that require certification of an oral health assessment as a condition of school entry:condition of school entry:condition of school entry:condition of school entry:
Overall, more than a quarter of states now have some requirement Overall, more than a quarter of states now have some requirement for a dental certificate for schoolfor a dental certificate for school--aged childrenaged children
Data needed to know if policy improves child health or family Data needed to know if policy improves child health or family health literacyhealth literacy
More information: More information: http://nmcohpc.net/2008/statehttp://nmcohpc.net/2008/state--lawslaws--dentaldental--screeningscreening--schoolagedschoolaged--childrenchildren
1212
5/17/2011
7
IL Dental Screening LawIL Dental Screening Law
Students in public, private and parochial school must comply
All children in kindergarten, second and sixth grades are required to have a dental examination by May 15th of each year
Waiver is issued for religious, undue burden and lack of access concerns
Data is maintained by Board of Education and Department of Public Health
In the 2005-06 school year, the first year of the new law, the dental compliance level of all students in all reported schools was 80.3%. The compliance level of public schools was 78.8% and of non-public schools was 90.6%.
See: See: http://www.astdd.org/docs/FinalSchoolScreeningpaper10http://www.astdd.org/docs/FinalSchoolScreeningpaper10--1414--08.pdf08.pdf1313
Community Water FluoridationCommunity Water FluoridationFor every $1 invested in community water For every $1 invested in community water fluoridation, $38 is saved in dentalfluoridation, $38 is saved in dentaltreatment coststreatment costs. (CDC). (CDC)
The The Fluoride Legislative User Information Fluoride Legislative User Information Database (FLUID)Database (FLUID) is an online legal and is an online legal and policy database that is...policy database that is...
ComprehensiveComprehensiveUserUser--friendlyfriendlyInformativeInformative
Addresses policy and case law at federalAddresses policy and case law at federalAddresses policy and case law at federal, Addresses policy and case law at federal, state, and local levels. Available at state, and local levels. Available at www.fluidlaw.orgwww.fluidlaw.org
SearchSearchCase LawCase LawPoliciesPoliciesFederal ActionsFederal Actions
1414
5/17/2011
8
State Strategy ExampleState Strategy Example
Arkansas Statewide Law (Act 197) Arkansas Statewide Law (Act 197) ––fl id ti ffl id ti f i t l 32 dditi li t l 32 dditi lfluoridation forfluoridation for approximately 32 additional approximately 32 additional community water systems in Arkansascommunity water systems in Arkansas
Took a “village” to pass:Took a “village” to pass:Coalition worked with CDC/CDHP Oral Health Coalition worked with CDC/CDHP Oral Health P li T l d i iti d li hP li T l d i iti d li hPolicy Tool and prioritized policy changePolicy Tool and prioritized policy changePew Campaign StatePew Campaign StateMultiple partnersMultiple partners
1515
School based/linked dental sealant School based/linked dental sealant programs (SBSPs)programs (SBSPs)
CDC reports SBSPs can reduce decay by CDC reports SBSPs can reduce decay by up to 60%*up to 60%*
Yet only 32% of children aged 8 years have Yet only 32% of children aged 8 years have received sealants in the US and disparities received sealants in the US and disparities ppexist in receipt of sealants*exist in receipt of sealants*
* * CDC Oral Health Program Strategic Plan 2011CDC Oral Health Program Strategic Plan 2011--20142014
1616
5/17/2011
9
State Strategy ExampleState Strategy Example
In SC, for example, dental sealant usage among 3rd d i d 20 t 24 % f 2002 t3rd graders increased 20 to 24 % from 2002 to 2008, with no racial disparity in status of sealant use (and untreated decay declined from 32% to 22%).
O l h lth ill i f t t t &Oral health surveillance, infrastructure support & funding, + policy changes related to Medicaid reimbursement and workforce seen as contributing factors.
1717
Other OptionsOther OptionsIncrease Medicaid reimbursement rates to Increase Medicaid reimbursement rates to t l t id t f d lit l t id t f d liat least cover provider costs of delivery careat least cover provider costs of delivery care
Michigan Pilot: Commercial Carrier (Delta) Michigan Pilot: Commercial Carrier (Delta) representing Medicaid representing Medicaid
States with State supported Dental Schools:States with State supported Dental Schools:Loan repayment/forgiveness for establishing Loan repayment/forgiveness for establishing practice in an underserved areapractice in an underserved area
1818
5/17/2011
10
State / FederalState / Federal
Children’s Health Insurance Program (CHIP)Children’s Health Insurance Program (CHIP)
Federally Qualified Health Center (FQHC) Federally Qualified Health Center (FQHC) public / private contractingpublic / private contracting
Affordable Care Act (ACA) State ExchangesAffordable Care Act (ACA) State Exchanges
1919
State focus on CHIPState focus on CHIP
Federal Children’s Health Insurance Program (CHIP) nowFederal Children’s Health Insurance Program (CHIP) nowFederal Children s Health Insurance Program (CHIP) now Federal Children s Health Insurance Program (CHIP) now provides comprehensive approach to oral health for kidsprovides comprehensive approach to oral health for kids
–– dental coveragedental coverage–– access to information on available providersaccess to information on available providers–– increased accountabilityincreased accountability
Optional state policy, states with separate CHIP plans Optional state policy, states with separate CHIP plans p p y p pp p y p pmay provide supplemental dental coverage to CHIP may provide supplemental dental coverage to CHIP incomeincome--eligible children with medical coverageeligible children with medical coverage–– Iowa only state that has currently implementedIowa only state that has currently implemented
See:See:http://www.cdhp.org/resource/access_child_only_supplemental_dental_coverage_through_chiphttp://www.cdhp.org/resource/access_child_only_supplemental_dental_coverage_through_chipra_handbook_advocates_and_policyra_handbook_advocates_and_policy 2020
5/17/2011
11
PublicPublic--Private Partnerships:Private Partnerships:FQHC Contracting for Dental ServicesFQHC Contracting for Dental ServicesFederal legislation clarified that Federally Qualified HealthFederal legislation clarified that Federally Qualified HealthCenters (FQHCs) may contract with private dentists:Centers (FQHCs) may contract with private dentists:
Expands FQHC’s ability to meet community need while Expands FQHC’s ability to meet community need while engaging private dentistsengaging private dentistsPatients remain FQHC patients, private dentists can see Patients remain FQHC patients, private dentists can see patients in their office and negotiate payment contract withpatients in their office and negotiate payment contract withpatients in their office and negotiate payment contract with patients in their office and negotiate payment contract with FQHCFQHCEndorsed by the American Dental Association (ADA) and Endorsed by the American Dental Association (ADA) and the National Association of Community Health Centers the National Association of Community Health Centers (NACHC).(NACHC).
See: See: http://www.cdhp.org/resource/FQHC_Handbookhttp://www.cdhp.org/resource/FQHC_Handbook 2121
Health Reform Health Reform –– State ExchangesState Exchanges
2010 Affordable Care Act (ACA), state insurance markets or2010 Affordable Care Act (ACA), state insurance markets or“Exchanges” are to be set“Exchanges” are to be set--up by 2014 up by 2014
In the establishment of Exchange(s) In the establishment of Exchange(s) –– decisions include decisions include requirements of insurers, consumer protections, essential benefitsrequirements of insurers, consumer protections, essential benefitsStates have discretion regarding participating plans, rates, and States have discretion regarding participating plans, rates, and –– to to some degree some degree –– available benefitsavailable benefitsPediatric dental care is mandated Essential Benefit Pediatric dental care is mandated Essential Benefit –– but much has but much has yet to be determined about design, consumer protections and outyet to be determined about design, consumer protections and out--ofof--pocket expensespocket expenses
More information: More information: http://cdhp.org/cdhp_healthcare_reform_centerhttp://cdhp.org/cdhp_healthcare_reform_center
2222
5/17/2011
12
Information AvailableInformation Available
Children’s Dental Health ProjectChildren’s Dental Health Projectdhdhwww.cdhp.orgwww.cdhp.org
National Maternal and Child Oral Health Policy CenterNational Maternal and Child Oral Health Policy Centerwww.nmcohpc.orgwww.nmcohpc.org
Fluoride Legislative User Information Database (FLUID)Fluoride Legislative User Information Database (FLUID)Fluoride Legislative User Information Database (FLUID)Fluoride Legislative User Information Database (FLUID)www.fluidlaw.orgwww.fluidlaw.org
2323
Oral Health and the Affordable Care Act
Rebecca AlderferManager, Strategic InitiativesPew Center on the States
5/17/2011
13
Agenda
1. Brief Overview of the Pew Children’s Dental Campaign
2. Dental Coverage under Affordable Care Act
3. Programs with Direct Funding
4. Authorized Discretionary (Annual) Oral Health Programs
5. Commissions and Federal Initiatives (for information only)
25
6. Summary and Questions.
About The Pew Center on the States
26
5/17/2011
14
Our Work• Fiscal Health
• Government Performance
• Election Initiatives
• Partnership for America’s Economic Success
• Pew Children’s Dental Campaign
• Pew Home Visiting Campaign
• Pre-K Now
27
• Public Safety Performance Project
• Results First
• Stateline
Pew’s Children’s Dental Campaign
Mission:
To promote policies that will help millions of children maintain healthy teeth, and come to school ready to learn.
28
5/17/2011
15
Focusing on Three Policy Areas
Prevention
• Community water fluoridation campaigns (CA, AR, MS)
• National messaging & strategy development
Funding for care
• Advocating for federal funding and support for oral health programs
• Medicaid reimbursement for fluoride varnish by MDs and RNs
29
varnish by MDs and RNs
Dental Workforce
• Ensuring adequate workforce to care for children (MN, CA, ME, NH)
• Research on economics of new models
Pew Campaign Federal Agenda: Supporting State Policy
• Increasing federal financial investments in oral health gprevention and care; including workforce
• Improving federal Medicaid, Community Health Centers, and grant program policies and criteria to ease barriers to care
• Showcasing state models for pragmatic, cost-effective reform and recruit national champions
30
and recruit national champions
• Serving as a resource and liaison to federal policymakers and state campaign advocates
5/17/2011
16
Dental Coverage in the Affordable Care Act
31
State Health (Insurance) ExchangesEssential Health Benefits RequirementsA pediatric dental benefit is required in the essential benefits package of the new State exchangespackage of the new State exchanges
Timing: January 1, 2014
Agency: Secretary of Health and Human Services
Authorization: New
32
• Pediatric dental benefit is yet undefined • Secretary is charged with defining the scope of the
benefits. The Institute of Medicine is running a process to gather input.
5/17/2011
17
Medicaid ExpansionMedicaid Expansion for the Lowest Income PopulationsMandates that states set their Medicaid income eligibility cap no lower than 133% of FPL. Coverage extended to all citizens gmeeting the income eligibility standard (childless adults)
Timing: January 1, 2014
Agency: Secretary of Health and Human Services
Authorization: New
33
• Raises eligibility for 6-19 year olds in 20 states: AL, AZ, CA, CO, DE, FL, GA, KS, MS, NV, NY, NC, ND, OR, PA, TN, TX, UT, WV, WY
• Option for states to adopt this expansion before 2014
Funding for CHIP
Extends CHIP through FY 2015Funding for the Children’s Health Insurance Program (CHIP) isFunding for the Children s Health Insurance Program (CHIP) is extended through fiscal year 2015, effective immediately, and the program is authorized to continue through 2019.
Timing: Funded March 23, 2010 - FY 2015Authorized to continue through 201923% FMAP increase beginning FY 2016
34
Authorization: New/amends existing
5/17/2011
18
Summary of Dental Coverage
• ‘Almost’ universal dental coverage for children– Paired with the requirement to carry health insurancePaired with the requirement to carry health insurance– Estimated 5.3 million additional children will obtain dental
coverage
• Adult dental coverage continues to be optional under Medicaid
– States continue to drop adult dental benefits due to budget t i t
35
constraints
• Adult dental coverage not included as part of the essential benefits package to be offered in the state exchanges.
Programs with Direct Funding in ACA
36
5/17/2011
19
Supporting the Dental Safety NetCommunity Health Centers FundAppropriated $11 billion to the CHC program
• $9.5 billion to expand operational capacity and enhance health services, including oral health services
• $1.5 billion for construction and renovation of community health centers
National Health Service Corps FundAppropriated $1.5 billion to the National Health Service Corps
• Programmatic improvements and placement of estimated 15,000 primary care providers in shortage areas
Grants for the Establishment of School-Based Health Centers
37
Appropriated $200 million• Restricted to expenditures for facilities; cannot be used for
operations• HRSA recently announced approx. $50 million for estimated 1,000
SBHC grants in FY 2010Source; National Association of Community Health Centers. “Community Health Centers and Health Reform: Summary of Key Health Center Provisions.” 2010. http://www.nachc.com/client/Summary%20of%20Final%20Health%20Reform%20Package.pdf (accessed May 19, 2010)
Prevention and Public Health Fund: FY2010-FY 2011 Allocations
• FY 2010 = $500 million allocation– $250 million to support training for and expansion of the primary
care workforce– $250 million for prevention
• FY 2011 = $750 million allocation
– $298 million to support community prevention
– $182 million to support clinical prevention
38
– $137 million to support public health infrastructure and training
– $133 million to support research and tracking
• FY 2012 = $1 billion allocation (proposed)
Source: U.S. Department of Health & Human Services. “Fact Sheet: Creating Jobs and Increasing the Number of Primary Care Providers.” July 8, 2010. http://www.healthreform.gov/newsroom/primarycareworkforce.html (accessed 7/8/10).Source: U.S. Department of Health & Human Services. “Affordable Care Act: Laying the Foundation for Prevention.” July 8, 2010. http://www.healthreform.gov/newsroom/acaprevention.html (accessed 7/8/10).
5/17/2011
20
Supporting Public Insurance
Medicaid and CHIP Payment and Access Commission (MACPAC) -- Assessment of Policies Affecting All Medicaid BeneficiariesExpands duties originally set out in the Children’s Health Insurance Reauthorization. Including ‘how factors affecting expenditures and payment methodologies enable beneficiaries to obtain services, affect provider supply, and affect providers that serve a disproportionate share of low-income and other vulnerable populations.
Ti i FY 2010
39
Timing: FY 2010
Funding: $11 million for FY 2010
Authorization: Amends existing authorization, members already named
Authorized Discretionary y(Annual)
Oral Health Programsin ACA
40
5/17/2011
21
Supporting Public Health• 5-year national, public education campaign focused on oral healthcare
prevention and education
• Demonstration grants to show the effectiveness of research-based dental caries disease management activities
• Expanded oral health surveillance collections; national and state specific
41
• Expanded cooperative agreements to improve oral health infrastructure
• Requirement that all states, territories and Indian tribes receive grants for school-based dental sealant programs
Demonstrations and evaluation of alternative dental health care providersGrant funds are to be used to train or employ new types of dental providers in order to increase access to dental health care services in rural and other underserved communities.
Supporting the Dental Workforce
Timing: 5-year program to begin no later than March 23, 2012, funding can start in March 2011
Agency: Secretary of Health and Human Services; Contract with the Institute of Medicine for program evaluation
42
Funding: Authorized; each grant will be at least $4 million, to be distributed over the life of the 5-year project – total of at least $60 million
Authorization: New, requires compliance with state law
5/17/2011
22
Expanded dental training programsThe Secretary may make grants to, or enter into contracts with, a school of dentistry, public or nonprofit private hospital, or a public or
Supporting the Dental Workforce
y, p p p p , pprivate nonprofit entity to establish and improve training programs, provide student financial assistance, provide technical assistance and support faculty loan repayment programs.
Timing: FY 2010 - FY 2015
Agency: Secretary of Health and Human Services
43
Funding: FY 2010: Authorized to be appropriated $30 millionFY 2011-FY 2015: such sums as necessary
Authorization: Amends Title VII of the Public Health Service Act
Supporting the Dental Safety NetSchool-Based Health Center GrantsRequired basic services include “referrals to, and follow-up for, specialty care and oral health services”
Timing: FY 2010-FY 2014
Agency: Secretary of Health and HumanServices, Bureau of Primary Healthcare
44
Funding: Authorized such sums as necessary• Covers operation and equipment costs for existing facilities
Authorization: Amends Title III of the Public Health Service Act (42 U.S.C. 280h et seq.)
5/17/2011
23
Federal Initiatives(For Information Only)
45
Department of Health and Human Services -Oral Health Initiative 2010
Thi i iti ti tili t h t tThis initiative utilizes a systems-approach to create and finance programs to:• Emphasize oral health promotion/disease
prevention• Increase access to care• Enhance oral health workforce• Eliminate oral health disparities
46
• Eliminate oral health disparities
http://www.hrsa.gov/publichealth/clinical/oralhealth/hhsinitiative.html
Source: U.S Department of Health and Human Services, Health Resources and Services Administration. 2010. “HHS Oral Health Initiative.” http://www.hrsa.gov/publichealth/clinical/oralhealth/hhsinitiative.html (accessed May 21, 2010)
5/17/2011
24
HRSA and Institute of Medicine Projects
Oral Health Access to ServicesPurpose: Examine issues that affect underserved
populations that are most vulnerable to oralpopulations that are most vulnerable to oral disease and the role of public and private safety net providers, with a specific focus on women and children.
An Oral Health InitiativePurpose: Explore ways to increase public
f th l ti hi d i t f
47
awareness of the relationship and importance of good oral health to good physical health; promote prevention and improve oral health literacy to health providers and the public; and recommend ways to improve access to oral health care.
Source: Institute of Medicine of the National Academies. Activities, Consensus Study. Last Updated Feb 25, 2010. “Oral Health Access to Services.” http://iom.edu/Activities/HealthServices/OralHealthAccess.aspx (accessed 7/12/10)
Summary and Questions
48
5/17/2011
25
Summary • New insurance coverage and new resources
– Estimate 5.3 million children could gain dental coverage– Expansion of Community Health Center operational and
facilities grantsfacilities grants– Authorized programs supporting prevention and workforce
• Action still needed: To secure federal investment in authorized dental programs
49
Rebecca Alderfer, [email protected]
5/17/2011
26
Bob Russell, DDS, MPHDental Director, Iowa Department of Public Health
INSIDE I‐SMILE™: 2010
51
Multiple Locations:Multiple Locations:
52
Multiple Multiple Providers: Providers: dentists, dentists, hygienists, hygienists, nurses, nurses,
physiciansphysicians
Multiple Locations: Multiple Locations: private practices, private practices,
clinics, public health clinics, public health settingssettings
Integrated Integrated services: services:
prevention, care prevention, care coordination, coordination, treatment, treatment, educationeducationp ys c a sp ys c a s educationeducation
5/17/2011
27
53
54
55% more Medicaid eligible (ME) children receive care from dentists
58% more ME children receive preventive care from dentists
Title V (Maternal and Child Health Services Block Grant) staff provide care to 3x as many ME children than before
5/17/2011
28
55
One in ten children at WIC (6 months‐4 yrs) have untreated decay
One in five children ages 3‐4 at WIC have untreated decay
17% of children screened before kindergarten have a dental treatment need
Dentists:
56
Less than 1% of ME children received an exam before the age of 1
10% received a service from a dentist before turning 2
Title V/Public Health:Title V/Public Health:
6% of ME children received a screening before the age of 1
15% received a screening and/or fluoride before the age of 2
5/17/2011
29
57
639 children received fluoride varnish from medical practitioners in 2010 (up from 13 in 2005)
School dental screening requirement is increasing the number of children who are ready to learn
I‐Smile™ Coordinators are successful in building partnerships and local infrastructure
Dental Screening Requirement
58
RequirementCreated by Iowa legislature in 2007; implemented 2008-2009 school year
Overall goal: Improve the oral health of Iowa’s children
5/17/2011
30
Who is included?
• Any student seeking enrollment in
59
y gkindergarten or 9th grade in an Iowa public or accredited non-public elementary or high school
• Exemptions allowed for:• Religious reasons• Financial hardship
Who can provide screening?
• Kindergarten
60
– Dentist or dental hygienist– Physician, physician assistant,
registered nurse or nurse practitioner• 9th grade
– Dentist or dental hygienist
5/17/2011
31
SCHOOL SCREENING RESULTS
2008-2009: 57% of students with valid certificate
61
No problems
RequireCare
RequireUrgent Care
DDS RDH MD/DO PA RN/ARNP
2008‐2009
84.1% 12.7% 2.3% 67.7% 25.5% 0.4% 0.1% 4.3%
2009-2010: 70% of students with valid certificate
2009‐2010
83.7% 13.6% 2.7% 71.3% 22.9% 0.9% 0.2% 4.6%
I‐Smile™: The Future
Public‐private partnerships
62
Link with primary health care (I‐Smile™ risk assessment, dental diagnosis codes, electronic health records)
Improvements to Medicaid
Workforce considerations
Public education and oral health promotionp
Outreach to dentists and physicians about the oral health needs of very young and at‐risk children
More gap‐filling services within public health to prevent disease
5/17/2011
32
63
Bob Russell, DDS, MPHIowa Department of Public Health
Bureau of Oral and Health Delivery Systems1‐866‐528‐4020
Additional ResourcesNCSL's States Implement Health Reform: Oral Health brief
http://www.ncsl.org/?tabid=22477
NCSL Children’s Oral Health pagehttp://www.ncsl.org/?tabid=14495
Pew Children’s Dental Campaignhttp://www.pewcenteronthestates.org/initiatives_detail.aspx?initiati
veID=42360
Children’s Dental Health Projecthttp://www.cdhp.org/
Health and Human Services: Center for Disease Controlhttp://www.cdc.gov/oralhealth/
5/17/2011
33
Any Questions?
• Use the Q and A panel on your screen.• To find the archived webinar next week go to • To find the archived webinar next week, go to
http://www.ncsl.org/?tabid=22359• Please fill out the survey at the end of this
webinar.
For additional information please contactFor additional information, please contactTara Lubin: [email protected] or
Jen Wheeler: [email protected]
Thank you!