By Erik Skinner
On a muggy Monday morning in Music City, NCSL’s Health Program kicked off its general sessions for the 2019 Legislative Summit.
Oral health was the topic. Exploring oral health policies that maximize state efforts to improve access and increase quality of care was the goal. Expert speakers included Marko Vujicic, a world-renowned health economist and vice president of the American Dental Association’s (ADA) Health Policy Institute, and Marcia Brand, a national expert on oral health programs with decades of experience in Congress and various federal health agencies, currently a senior advisory for the DentaQuest Partnership for Oral Health Advancement.
Vujicic kicked off the meeting by discussing national trends in oral health care regarding coverage, utilization and access. He described the concept of changing the value proposition when policymakers discuss investments and commitments to oral health. Data from the ADA’s Health Policy Institute includes:
- 29% of low-income survey respondents reported that the appearance of their mouth affects their ability to interview for a job.
- 20% of low-income survey respondents reported that their mouth and teeth are in poor condition.
- 46% of high-income adults report the overall condition of their mouth as very good, compared to 15% of low-income adults.
There are differences in the rates of utilization for annual dental visits for children, dental visits for the elderly and emergency department visits for adults. Public versus private coverage, socioeconomic status, rural/urban residence and race often drive these differences.
State data collection for type of insurance coverage, insurance utilization and dental emergency department utilization is of interest to policymakers looking to identify the most pressing oral health challenges in their states. The information is also relevant to conversations about projecting the future supply of dental providers and modeling the fiscal impact of oral health policy proposals.
Brand led the session into a discussion of specific oral health efforts underway in the states. States are engaged in many efforts to increase access by supporting provider reimbursement, providing extensive oral health care to children, improving dental public health infrastructure and supporting oral health efforts within maternal and child health programs.
Colorado, Pennsylvania, Oregon and South Carolina participate in the MORE (Medical Oral Expanded Care) program, which uses a learning collaborative process to integrate oral health for children and adults through an interprofessional team. The program also tests optimal patient-centered referral systems between dental and primary care teams. In 2016, the pilot program expanded to include more states to test oral health integration strategies and the development of dental referral networks.
Brand also discussed innovative approaches to oral health in California, Oregon, Texas, Washington and West Virginia, including encouraging value-based care in oral health programs, establishing oral health surveillance systems and using telehealth technologies. State legislators can play a variety of roles in supporting oral health policy by:
- Proposing legislation.
- Serving as a convener of oral health stakeholders.
- Establishing a legislative oral health caucus within the legislature.
- Arranging or attending oral health days at the state capitol.
Senator Clarence Lam (D), a practicing physician from Maryland, pictured above, right, highlighted the importance of prevention by telling the tragic story of Deamonte Driver, a 12-year-old Maryland boy who died with a severe brain infection after his dental problems went untreated. Since then, Maryland has made significant gains in dental coverage for children and adults in the state.
Representative Steve Eliason (R-Utah), above left, summarized a series of bills he introduced to provide coverage and patient-centered care for the homeless, children with developmental disabilities and Medicaid-eligible beneficiaries in a substance use disorder (SUD) treatment program. For example, Utah HB 435 increased coverage, decreased rates of relapse and increased employment for the population with SUD. There was no cost to the state because the University of Utah School of Dentistry agreed to provide the dental care for free.
For related information and inquiries about state policy and oral health, contact Erik Skinner in NCSL’s Health Program.
LegisBrief: Oral Health Care in Rural America
LegisBrief: Oral Health and Pregnancy
Postcard: Dental Health Professional Shortage Areas
Session Slides: State Oral Health Efforts – Extracting Value and Improving Access
Erik Skinner is a policy associate in NCSL's Health Program.