By Erik Skinner
The worlds of oral health and primary care increasingly converge.
Both disciplines refer to the “oral health physician,” describing an oral health provider who also administers basic primary care screening and counseling to patients.
Economic research frames the “primary care gap,” or the difference between primary care providers and patients in need of health services, as a supply and demand issue that dentists can address.
Oral health providers can address primary care shortages, to the extent their licenses allow, by providing screening, counseling and referrals to patients that struggle to access primary care.
Below are state examples that incorporate these ideas into laws addressing the ability of oral health providers to provide primary care or oral care in primary care settings.
Some states manage and finance oral health services in their Medicaid programs. In 2019, the New Hampshire General Court enacted HB 692, which extends dental coverage to the adult population in Medicaid. The law also includes options for traditional capitated managed care, an administrative services organization, an accountable care organization and a primary care case management model—all of which would allow for financing oral health services like primary care services.
One of the first states to include oral health in the financing of primary care, Oregon aimed to improve access and quality by integrating oral health into the traditional medical system. Oregon enacted HB 3650 in 2011 and created a new payment and delivery structure in its Medicaid program called a coordinated care organization (CCO). In the following years, CCOs and accountable care organizations (ACOs) in Iowa, Minnesota and Ohio started to incorporate dental services, along with physical and behavioral health, as covered services in their beneficiaries’ primary care plans.
Several states address oral health and primary care through incentives to attract providers to oral health and primary care shortage areas. All 50 states and Washington, D.C., have state or federal options for a dental loan forgiveness program. While state programs vary, eligible dentists can participate in the U.S. Public Health Service, the Faculty Loan Repayment Program and the Public Service Loan Forgiveness Program.
In 2018, the Maine legislature enacted SB 439 to extends the primary care access credit to eligible dentists practicing in underserved areas. The program classifies dentists as primary care providers and increases the number of total providers from five to 10 per year. In 2018, the Ohio legislature enacted SB 259.
The law calls on the deans of the Ohio State University College of Dentistry and the Case Western University School of Dentistry to jointly develop a proposal for the creation of a primary care dental student component of the Choose Ohio First scholarship program. This program requires recipients to work in a federally recognized dental health professional shortage area.
States can also look to federal programs and other organizations that are working on this issue. The Health Resources and Services Administration provides technical assistance to providers and systems looking to integrate oral health services into their practice. The National Network for Oral Health Access also provides integration resources to guide oral health and primary care policymakers and stakeholders. For more information, explore the resources from NCSL and other partners.
Erik Skinner is a policy associate in NCSL's Health Program.