1. Oral Health Initiative John Rossetti, DDS, MPH HRSA/Chief Dental Officer Dee Raisl HCFA/Regional Maternal and Child Health Specialist Jim Sutherland, DDS, MPH HRSA/Regional Dental Consultant

2. Dental Epidemiology n Dental caries is the most common disease among U.S. children (NHANES). n 80% of dental disease is concentrated in 25% of children (NIDR). n Low income and minority children are less likely to receive dental treatment. n Caries in toddlers and infants is most severe among minorities and low income children.

3. US Yr 2000 Obj. (Healthy People 2000, US DHHS US NIDR (National Survey of Dental Caries in US School Children, US DHHS) NHANES III (National Health and Nutrition Examination Survey) WASHINGTON (A Children’s Oral Health Assessment Report 1996) OHIO (The Oral Health of Ohioans 1993) MARYLAND (Survey of the Oral Health Status of MD’s School Children 1995) CALIFORNIA (Oral Health Needs Assessment of Children 93-94

4. US Yr 2000 Obj. (Healthy People 2000, US DHHS US NIDR (National Survey of Dental Caries in US School Children, US DHHS) NHANES III (National Health and Nutrition Examination Survey) WASHINGTON (A Children’s Oral Health Assessment Report 1996) OHIO (The Oral Health of Ohioans 1993) MARYLAND (Survey of the Oral Health Status of MD’s School Children 1995) CALIFORNIA (Oral Health Needs Assessment of Children 93-94

5. Historical Perspective in Federal Programs n For years Medicaid and our partner programs have reported that dental care is the hardest service to access for our recipients. n In 1991 a survey by the Association of State and Territorial Dental Directors found multiple problems in the state dental programs. n The Office of Inspector General Report: Childrens Dental Services under Medicaid - Access and Utilization (1996) identified the lack of provider participation and low prioritization by families among the reasons only 1 in 5 children were receiving care. n Creation of the State Children’s Health Insurance Program in 1997 was going to exacerbate already overwhelming access issues.

6. Historical Perspective in Dental Community n Overhead costs in dental offices run above those in other medical settings. n Most dental practices are full, with the majority of patients paying 100 percent of the billed charges. n Recent surveys indicate that 40 percent of the practicing dentists/specialists are slated to retire within 10 years. n Dental schools are closing. n The number of students in the remaining schools is decreasing. n 300 teaching positions remain vacant, preventing the above trends from changing in the near future.

7. What Do We Hope to Do? n Eliminate disparities and barriers to care. n Respond to the unmet needs for clinical services. n Increase the number of dental professionals. n Expand the dental public health infrastructure. n Restructure the oral health programs at the federal level, increasing the coordination between agencies which fund different aspects of the delivery system. n Coordinate federal initiatives with key dental community partners.

8. Oral Health Initiative The main components of the initiative are: -Integrating activities within and between federal agencies -Partnering with stakeholders -Sharing scientific data

9. Integrating activities within and between federal agencies. n Held first joint conference on oral health issues in Tahoe. n Expanded membership of the OHI Central Office Team. n Established OHI Regional Teams including HCFA and HRSA. n Facilitated development of the OHI Regional Teams by establishing a common understanding of all the issues. n Expanded the initiative to the Head Start and Women, Infants and Children food programs.

10. Partnering with Stakeholders n Invited representatives of the American Dental Association to join each Regional OHI Team. n Established programs on children’s access to dental services through Medicaid with the following: National groups state officials (NCSL, APHSA, NASMD, AMCHP, ASTDD, RSG)National groups state officials (NCSL, APHSA, NASMD, AMCHP, ASTDD, RSG) Professional groups (NACHC, ADA, NDA, AAPHA, AADS, AAPHD)Professional groups (NACHC, ADA, NDA, AAPHA, AADS, AAPHD) Advocacy groups (Families USA, CDF, MOD), andAdvocacy groups (Families USA, CDF, MOD), and Business groups (Delta Dental, BC Dental, NADP).Business groups (Delta Dental, BC Dental, NADP).

11. Sharing scientific data n Compile existing information from: NMES/MEPS, NHIS,NHANES, Healthy People, Head Start, WIC, Medicaid reports n New Surveys to be completed: APHSA Survey of Medicaid directors AMCHP Policy Brief NCSL study of dentists’ participation in Medicaid MOD promotion of early interventions Healthy Partners survey of general populations versus Medicaid utilization Ohio State Study of Medicaid use of EMS Reforming States Group Dental Medicaid monograph and actuarial study NCQA Dental HEDIS measures development with B testing

12. How We’re Getting There Complete a series of tools that stakeholders can use to assess and reform programs to include Complete a series of tools that stakeholders can use to assess and reform programs to include : Patient Satisfaction Survey Tools Dental Managed Care contracting language NCQA pediatric dental HEDIS report Geographical Information System (GIS) mapping program - interactive, web-based Actuarial Models Workforce Models

13. and Support State activities to identify and strategize solutions to barriers to care issues such as: Assist in the development of and funding for state dental summits. Help States’ identify and apply for infrastructure support grants. Expand dental care discussion in EPSDT manual. Document the impact of reimbursement increases and/or restructuring on access to care. Develop information on dental expenditures - national versus Medicaid. Identify successful interventions/best practices and place the information on a web-site for public sharing. Place the RSG Medicaid reform model on the web.

14. Geographical Information System (GIS) Mapping n To conduct a comprehensive assessment of a state’s dental health infrastructure and dental services utilization using a variety of existing data sets, integrating the information into an interactive internet web-based site for easy retrieval. Currently targeting Colorado, North Dakota and South Dakota Data provided on a county and zip code level. Elements to show demographic distribution of state population, public and private providers, dental programs, Medicaid population, Medicaid service utilization, water fluoridation systems, etc.

15. Future Dreams for the OHI n Expand funding for dental programs in Community Health Centers/Federally Qualified Health Centers and the capacity of existing programs. n Increase the number of grants for sealant programs. n Provide additional grants for fluoridation systems. n Expand the number of loans/scholarships available for dental students who are willing to practice in under-served areas. n Support the development of state dental health infrastructure through Community Information Support System and other grants. n Provide Geographical Information System mapping in all states.

16. Dreams Part II n Define appropriate changes for simplification of the process and requirements for Health Professional Shortage Area designation. n Change federal policies that restrict provider enrollment and access to care. n Test proposed HEDIS pediatric oral health measures. n Update the EPSDT dental manual in cooperation with the American Academy of Pediatric Dentists. n Study the impact of fee changes (increases or restructuring) on service delivery in Medicaid. n Study the impact of SCHIP on dental service availability in Medicaid.

17. Our GOAL: 100 % Access and 0% Health Disparities