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13 Reframing the System
Pages 107-124

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From page 107...
... Health Resources and Services Administration The Health Resources and Services Administration (HRSA) funds health centers, provides grants to support training and health workforce planning, and provides many other grants for maternal and child health and HIV and AIDS workforce issues.
From page 108...
... HRSA may have a role in improving access to oral health care services by increasing the amount of available data. Historically, HRSA has done a lot of work with different segments of the health care workforce, and so might be able to engage even more with oral health professionals.
From page 109...
... Within oral health, the FDOH has developed a state oral health improvement plan for disadvantaged persons, a comprehensive plan developed through a collaborative process between the public and private sectors that is working towards the development of an integrated, coordinated oral health system. Florida is unique among states in that local county health departments are a large part of the safety net, providing clinical operations and directly employing dentists, dental hygienists, and dental assistants in operatories throughout the state.
From page 110...
... Additionally, it has a role in the licensing and regulation of numerous health care professions including dental health professions through the Medical Quality A ­ ssurance Division. One of the leadership roles state health departments can provide is to educate legislators, dental organizations, and their boards of dentistry about the specific state-level workforce challenges and opportunities for improving access.
From page 111...
... State Government Tricia Leddy Rhode Island Department of Health State governments have multiple roles in improving access to oral health care services. As payors, states not only administer Medicaid but are also large employers (of state employees)
From page 112...
... Savings were reinvested into RIte Smiles, toward increasing primary dental care reimbursement rates. The second part of the strategy was to enroll all Medicaid-enrolled children under age 6 in the RIte Smiles dental benefit manager program, and thus improve their access to preventive dental services.
From page 113...
... This program uses federal job training funds to train mothers who are reaching their time limit on cash assistance to become dental assistants. States certainly have many opportunities to improve access to oral health care services.
From page 114...
... Finally, the efficiency of the dental safety net system can be improved with the more effective use of conventional allied dental health personnel (e.g., dental assistants)
From page 115...
... University of Florida College of Dentistry The existing dental education system is, in part, to blame for many of the problems faced in improving access to oral health services including the lack of practitioner participation in the Medicaid program, the opposition of organized dentistry to new workforce models (except their own) , and the restrictive dental practice acts of many state boards of dentistry.
From page 116...
... For example, the new CHIP legislation calls for an evaluation of the oral health status of children. Departments of public health and epidemiology within dental schools can provide expertise on how to design surveys.
From page 117...
... Advocacy and Coalition Building Michael Scandrett Halleland Health Consulting -- Minnesota Safety Net Coalition The Minnesota Safety Net Coalition (MSNC) is a group of safety net providers including community clinics and health centers, dental clinics, safety net hospitals, home- and community-based providers, and advocates who share a common interest in serving low-income, uninsured, and disadvantaged patients who face multiple barriers to accessing health care services.
From page 118...
... For example, aside from Medicaid and the traditional systems of care, Minnesota uses multiple strategies including critical access payments, collaboration with dental hygienists, expanded functions for dental assistants, legislative changes to include community health workers in dental care, and grants and loan forgiveness programs. To solve these problems, stakeholders need to come together, through coalitions or other means, so legitimate concerns can be heard and broad support for solutions to challenges can be created.
From page 119...
... The story of Deamonte Driver's life and death, as well as the many s ­ tories to follow, fostered a personalization of the barriers faced by poor families including systemic problems of the Medicaid system as well as personal obstacles such as transportation, transience, and erratic phone and mail ­service -- things that do not challenge middle-class families. Lowincome parents, just like other parents, often lack awareness about the importance of dental care, but this is more significant when a child does not get routine oral health visits.
From page 120...
... Several participants commented on the challenges of reimbursing oral health professionals aside from dentists. Brand and Davis agreed legislative change is often needed to give this authority.
From page 121...
... scholarships and loan repayment programs for dentists to serve in HPSAs, stating the government should prioritize these types of programs for oral health professionals. The participant commented on other possible strategies for targeting oral health in underserved areas by ­ financing and paying for services rendered by dental hygienists independently from dentists as well as the use of dental residents to serve in
From page 122...
... One participant referenced the Healthy Kids program in Michigan in which dental hygienists and dental assistants are allowed to perform e ­ xpanded duties, and participants in the Delta Dental Plan are automatically eligible to treat underserved patients. The participant attributed some of the success of the program to the effective use of a state-based lobbyist and annual legislative visits at the state and national levels, but recognized the challenge of budgetary limitations.
From page 123...
... , Brand said this lifestyle change is common to all professions, including nonhealth professions. One participant commented private practice patterns will not change to become more efficient because dentists like the traditional slow pace of private practice.


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