By Erik Skinner
Oral health influences how we grow, enjoy life, look, speak, chew, taste food and socialize. Poor oral health can make finding employment more difficult.
Many chronic conditions coalesce across the areas of oral, physical and mental health. For example, poor dental care during pregnancy can have negative outcomes for both mothers and babies; individuals with gum disease have an increased risk of heart disease; and oral health care can improve treatment outcomes for substance use disorder patients.
In 2019, state lawmakers enacted legislation to monitor, measure, manage and mandate the coverage of oral health services for their citizens. The following enacted oral health bills also include issues that affect the broader health system, such as licensure policies, health workforce issues, special or high-risk populations, insurance issues and oral health integration in primary care practices.
Children’s Oral Health Services in Schools
Illinois passed HB 2676 to amend the Dental Practice Act. The bill states that after completion of a training program, a public health dental hygienist may operate in a public health setting that meets specified requirements with a dentist who is working in, or has contracted with, a local or state government agency or institution, or who is providing services as part of certain school-based programs.
Similarly, lawmakers in Rhode Island enacted SB 572, which includes any eligible licensed public health dental hygienist to conduct dental screenings for children in kindergarten, third and ninth grade.
Dental Services and Workforce in Rural Areas
To address rural access to oral health services, the Connecticut legislature passed HB 7122. The bill allows a mobile dental clinic to submit claims for Medicaid reimbursement for services within 30 miles from the fixed dental location associated with the clinic. The rural counties of Litchfield, New London and Windham are excepted, extending the distance limit to 50 miles. It also authorizes licensed dentists and dental hygienists who meet licensure requirements to provide services.
Another way to improve access to oral health services in rural areas is to address the oral health workforce. Florida lawmakers enacted HB 843, establishing the Dental Student Loan Repayment Program. It supports dentists who practice in public health programs located in certain dental health professional shortage areas and medically underserved areas, which often include rural areas. The bill also establishes the Donated Dental Services Program to provide comprehensive dental care to eligible individuals.
Maine’s HB 502 addressed loan repayment for dentists. This bill increases the maximum loan repayment amount to $25,000 from $20,000 for eligible dentists practicing in underserved population areas. Another Maine law, HB 1014, adds an Early and Periodic Screening, Diagnostic and Treatment (EPSDT) dental coordinator to the Medicaid agency, who will produce a report with the state’s Rural Health and Primary Care Division. The report will include geographic areas not being covered by the division’s oral health programs, as well as recommendations.
Five state legislatures, including Connecticut, Idaho, Montana, Nevada and New Mexico, enacted legislation to allow for a new provider, dental therapists in 2019. Thirteen states now allow dental therapists to practice as dental providers.
Public Dental Coverage
Dental insurance rates for children are at historic lows. Although dental coverage gains for children have been increasing for decades, policymakers still seek ways to improve dental coverage and services for children. New Mexico legislators adopted Senate Motion 96 which requested the office of oral health in the Department of Health to convene a task force to study ways to expand Medicaid coverage to provide additional dental care to children.
In addition to addressing children’s oral health coverage, some states also consider the adult population. New Hampshire added dental coverage for its adult Medicaid population. HB 692 added dental benefits for the adult population through the Medicaid Managed Care Program. The statute previously excluded mandatory dental services from the program, program options include a primary care case management model. This law strikes the line excluding mandatory dental services and adds multiple sections detailing the composition of a working group to determine the oral health benefit and payment model. The working group includes a state primary care association along with oral health organizations, legislators and other stakeholders.
This has been a sample of the enacted oral health bills in 2019. For a deep dive into children’s oral health and oral health and pregnancy legislation, please visit NCSL’s Maternal and Child Health Database. The database tracks enacted legislation on a variety of topics, including oral health, in legislatures across the country.
Erik Skinner is a policy associate in NCSL's Health Program.