1. Improving Access to Oral Health Care in Washington State Christina Peters Health Policy Director, Children’s Alliance January 23, 2015 Families USA

2. Snohomish Co 2010 low-income needs assessment: dental care identified as #1 unmet need Chelan/Douglas Co 2010 community needs assessment quoted a local nurse that compared dental care access for adults “to that of a third world country” A 2012 assessment, homeless veteran’s self-identified dental care as the #1 unmet need Dental care is out of reach in Washington

3. Dental Care Shortage Areas in WA

4. Oct 23-26 in downtown Seattle at the Seattle Center, 3386 patients received care at a “Remote Area Medical” event which provides charity care to individuals who need it. 87% of patients came from the central Puget sound area 75% reported incomes below 200% FPL and 40% reported being uninsured. 92% of patients reported not having dental insurance People camped out overnight to gain access to the free clinic

5. 1714 patents received dental care which amounted to $1.24 million in dental services. 76% of dental patients require follow up 30% of dental providers (and 40% of supporting providers) agreed with the statement: “I discovered many conditions I couldn’t treat on site”

6. Dentists’ Participation in Medicaid FY 2009FY 2010FY 2011FY 2012 Number of licensed dentists* 5,9236,0726,1556,080 Number of dentists that serve Medicaid-enrollees** Based off claims payment data and age grouped 0-20 1,2261,3531,2141,165 21%22%20%19% Number of dentists that serve Medicaid-enrollees ** Based off claims payment data and age grouped 21 + 1,1111,210997626 19%20%16%10% *WA State Department of Health**WA State Health Care Authority

7. Increasing Access to Coverage Embedded Pediatric Dental Benefits offered in QHPs in the Exchange Oral Health Coverage and the Medicaid Expansion

8. Embedded Pediatric Dental Benefits Dental benefits offered in the exchange must be offered and priced separately to assure transparency for consumers

9. Embedded Pediatric Dental Benefits In 2014 we ran a bi-partisan bill with a very broad coalition of supporters – The Healthy Washington Coalition, Dentists, Big health plans like Premera and Regence The dental insurers led by Delta Dental were the main (and only) opposition to the bill The bill did not pass the senate

10. Embedded Pediatric Dental Benefits Consumer Choice Equal Markets Lower Costs

11. Medicaid Eligible January 1, 2014 *Estimate Reinstatement of Medicaid Adult Dental Newly Eligible Adults up to 133% FPL Over 700,000 * 280,000+ 450,000

12. Restoration of Adult Dental in Medicaid The Alliance of Dental Hygiene Practitioners Children’s Alliance Washington Dental Service Foundation Statewide Poverty Action Network UW School of Dentistry Washington State Dental Hygiene Association Washington Denturists Association Solid Ground Washington Association of Community and Migrant Health Centers Washington Senior Citizen Lobby SEIU Healthcare 775 NW Washington State Dental Association Eldercare Alliance Northwest Health Law Advocates Washington Association of Area Agencies on Aging Washington Dental Access Campaign Broad coalition including: Providers Children’s Advocates Senior’s Advocates Poverty Advocates Labor Unions Oral Health Advocates

13. Medicaid eligible adults receiving at least one dental service in FY 2013

14. Increasing Access to Care Dental Therapists A Community Workforce Solution to Improve Oral Health & Access to Quality Dental Care For Rural, Tribal & Underserved Washington

15. Why Dental Therapists? Dental Therapist provide high quality, community based, culturally competent care “They’ll get actually more training than a dentist does [within] a small scope of practice. I think a dental therapist model could be utilized in any dental office anywhere in the United States.” —Dr. Mary Williard, DDS 40,000 more Alaskans now receiving routine and preventative care because of dental therapists.

16. Dental therapists address cost and access issues Dental Therapists make the dental team more efficient On average, Dental Therapists cost only 30 cents for every dollar of revenue they generate. This allows dentists to see more Medicaid patients at existing reimbursement rates Preventive care offered by Dental Therapists can prevent costly emergency room visits for dental-related health problems. A solo-practice dentist in rural Minnesota is now taking 38 percent more patients after hiring a dental therapist. The practice increased the number of Medicaid patients served by 73 percent. Dental Therapists free up dentists to do more complicated procedures. “What we’re seeing on the ground is that not only is this an effective dental workforce provider, but it’s also well accepted by patients and by dentists when they have actual exposure to it.” —Sara Wovcha, Director of Children’s Dental Services, the first clinic to employ Dental Therapists in Minnesota.

17. Dental Therapists support strong families and healthy communities Dental Therapists bring jobs to their communities: for the dental team, as well as for office secretaries and even the landlord collecting rent from a once-empty storefront. Dental Therapist create an accessible rung on the health professional career ladder for communities underrepresented in the heath professions. In Alaska and Minnesota Dental Therapists are active members of their communities promoting good oral health in schools and other community settings. Dental Therapists strengthen communities by creating family wage jobs Dental Therapists provide culturally competent community based care Dental Therapists in Alaska and Minnesota are on the front lines of wiping out decay and improving overall health in underserved communities.

18. What’s the hold up? Supporters of Dental Therapy AARP of Washington Affiliated Tribes of Northwest Indians Alliance for a Just Society American Friends Service Committee American Indian Health Commission of Washington Asian Pacific Americans for Civic Empowerment (APACE) Center for MultiCultural Health Children’s Alliance Eastern Washington University Eastern Washington Voters Elder Care Alliance Equity in Education Coalition Faith Action Network Health Coalition for Children and Youth (HCCY) Healthy King County Coalition Latinos for Community Transformation LGBTQ Allyship National Association of Social Workers— Washington National Dental Association Northwest Portland Area Indian Health Board Olympia Coalition for a Fair Budget OneAmerica Para Los Niños Puget Sound Advocates for Retirement Action Real Change Resident Councils of Washington School Nurse Organization of Washington Sea Mar Community Health Centers Seattle Central Community College Seattle & King County Public Health Seattle NAACP SEIU Healthcare 775NW Senior Services Solid Ground Statewide Poverty Action Network UFCW Local 21 Washington Adult Day Services Association Washington Community Action Network Washington Low Income Housing Alliance Washington Rural Health Association Washington State Dental Hygienists’ Association Washington State Hospital Association Washington State Labor Council, AFL-CIO WA State Long-Term Care Ombudsman Program Washington State Senior Citizen's Lobby Opposition to Dental Therapy Washington State Dental Association American Dental Association