RIte Smiles: Improving Access to Oral Health Care

Volume 27, Issue 480 November 27, 2006

Anna C. Spencer

On Sept.1, Rhode Island launched RIte Smiles, a dental program designed to increase access to dental care for children enrolled in RIte Care, the Ocean State’s Medicaid program.

Already, the program is being hailed as a success. Since its inception, the number of dentists participating in Medicaid statewide has jumped from 27 to 129. As of Nov. 1, 30,000 children were enrolled in the program.

Like many other state Medicaid programs, Rhode Island historically has provided dental benefits to Medicaid beneficiaries on a fee-for-service basis. In 1999, at the behest of the Governor, a special Senate Commission on Oral Health was convened. Near the top of the commission’s list of recommendations was improving access to dental care for children.

In 1991, Rhode Island reformed its Medicaid program, establishing RIte Care as a capitated managed-care system. Now the state set out to improve access to dental care for low-income children by extending the same type of delivery system to dental care for kids.

RIte Care’s Dental Benefits Managed Program contracted with UnitedHealthcare Dental to administer RIte Smiles. The program—which is financed through reallocated Medicaid dental funs—delivers oral health services to qualifying children from birth to age six. Children must have been born on or after May 1, 2000, be eligible for medical assistance and not have other dental coverage. RIte Smiles covers a wide variety of types of care, including preventive (cleaning, fluoride), diagnostic, restorative (fillings and crowns), endodontics (root canals), oral surgery (extractions and mouth surgery), orthodontics, periodontal and prosthodontics (specialized replacement of missing teeth).

Focusing on kids birth through six “sets the stage for future oral health,” said Martha Dellapenna, the oral health project manager with the state Department of Health and Human Services. Unlike medical care, people often forego dental care until there is a serious problem, which increases the costs and health risks associated with dental care, she explained. “Getting people to the dentist early and regularly requires dispelling a number of myths and a huge amount of behavior change,” she added.

The UnitedHealthcare Dental program had to be committed to reaching out to the Medicaid community, said Dellapenna. They also had to be willing to work with their own providers to get them to participate in the program; under RIte Smiles, dentists don’t know which young patients are Medicaid beneficiaries and which ones aren’t—their receptionists simply see the UnitedHealthcare Dental card. “There is a lot of reluctance and mistrust on the part of providers about Medicaid patients,” she said. “United has worked very hard with their providers to encourage participation in the program, and the number of dentists willing to see RIte Smiles kids grows every day.” Among other things, UnitedHealthcare Dental does one-on-one recruitment of dentists in their offices, provides continuing education about pediatric dentistry and ensures that dentists get reimbursed more quickly than they did under the fee-for-service system.

Other Activities

In another effort to improve children’s oral health, Rhode Island used a three-year, $740,000 grant from the Robert Wood Johnson Foundation to increase the capacity of dental “safety net” providers in the state, expand Providence Smiles (a school-based prevention program) to additional school districts, and build workforce capacity by increasing the supply of pediatric dentists, dental hygienists and dental assistants in the state.

Prior to the grant, Rhode Island had no dental residency programs. The grant helped to develop two new residency programs that will graduate six dentists in 2007. Providers often remain in-state after their residency programs, increasing the workforce pool. The state also established a seven-week internship program to train individuals participating in the welfare-to-work Family Independence Program to be dental assistants. Finally, Providence Smiles, a mobile dental team that provides examinations, cleanings, sealants and oral health education in schools, was able to hire additional dental professionals to provide care in an expanded number of settings.

“In our effort to improve the oral health of our Medicaid beneficiaries, we opted for the scatter-shot approach,” said Dellapenna. “We tried to cover as many bases as possible.”

For more information about Rhode Island Oral Health Access Project, please visit http://www.rikidscount.org/matriarch/documents/OHAP%20Report%20Closing%20the%20Gap.pdf