Oral Health Plan

Update 4/13/01Raymond Lala, DDS

We envision a South Carolina where every child enjoys optimal oral health as part of total well-being and:

Prevention and education are priorities;Treatment is available, accessible, affordable, timely, and culturally competent;Responsibility is shared among parents, providers and insurers; andCollaboration by government, higher education, and the private sector ensures resources, quality, and patient protection.

National Governors’ Association

Education and Advocacy Public Non-dental providers Policy Makers Dental Providers

Dental Public Health Infrastructure Workforce Development and Funding

Education

Children’s Oral Health Coalition School survey 1999-2000

3% referred children completed treatment Oral health education

44% health educators – no oral health Barriers to access

Families lack money/insurance Dental care low priority for family Few dentists accept Medicaid

Regional School Nurse conferences

Oral Health Promotion

Create and disseminate OH Information“Seals on wheels” education programDental education task forceChildren’s Oral Health Coalition

Public Awareness

Oral Health Campaign Funding Partnership

Targeted Message Readiness to learn Relationship to overall well being

Prevention Programs

Prevention Programs

Dental SealantsFluoride VarnishTobacco Use NSTEP Smoking

Child Abuse and Neglect

Water Fluoridation

Presently only monitor MCL (EPA)CDC monitoring system (WFRS)2000 National Fluoridation CensusDisseminate information to local providers

Education of Non-Dental Providers

Collaboration with AHEC and MUSCRegional School Nurse ConferencesAdvanced Practice Nurse ConferencePerinatal AssociationsFamily Practice PhysiciansParenting CenterHead Start and Day CareSC Primary Health Care Association

Political Will

Budget major concern Delayed increase in SCHIP poverty

threshold MICH Council Eliminated

Advocacy Groups

Dental Provider Education

874 of 1561 DMD’s Medicaid enrolled (56%)Medicaid Provider education program Collaboration (SCDA, DHEC, DHHS,Family Connection) Targets entire dental team

Medicaid ad hoc committeeCollaboration with MUSC

National Governors’ Association

Education and Advocacy Public Non-dental providers Policy Makers Dental Providers

Dental Public Health Infrastructure Workforce Development and Funding

Public Health Dentistry

Prevent and Control dental diseaseCommunity as patientConcerned with: Dental education of the public Administration of group dental

programs Applied dental research Community efforts

Dental Public Health Infrastructure

1982-83 statewide needs assessmentChildren receiving a preventive dental service 12% HCFA, state data (1997-8) 25% as of 6/00 – Medicaid data

Dental disease EPSDT referrals 44% all referrals (PSHAP, 1997-98) 32% dental referrals not completed

DHEC initiated new statewide dental activity in June, 2000

Needs Assessment

Dental disease burden Update 1982 assessment in fall 2001

Human resources report from HRSASurveillance system BRFSS BSS (dental screenings) NOHSS

Advisory Group

Provide community specific consultationBlue Ribbon Task ForceOral Health Policy Academy TeamChildren’s Oral Health CoalitionDental Education Task ForceTobacco Collaborative

Special Needs

270,000 childrenFunding – Medicaid and CSHCNCSHCN Targeted population

Craniofacial anomalies Heart disease Seizures

Orthodontics

DDSNSpecial Olympics/Special Smiles

Community and Rural Health

Community Health Center safety netOnly 4 CHC sites with active dental clinics2 added to new funding requestsNo pediatric dentistsMost rural health centers are physician-only offices

Partnerships

Existing models Pediatric partnership model Volunteer Clinics Screening and referral programs

New Models Commun-I-Care in Allendale Primary Care Organizations

Community Based Programs

National Governors’ Association

Education and Advocacy Public Non-dental providers Policy Makers Dental Providers

Dental Public Health Infrastructure Workforce Development and Funding

Providers

MUSC class size reportHRSA study (Sheps center) on SCRank 45/50 in DMD/Pop. ratioRank 48/50 RDH/Pop. ratio41/46 counties are DHPSA’sOnly 47 pediatric dentists for 1 M <18 years of age

Workforce Report: Policy Options

Increase enrollment at MUSCIncrease pediatric dentists MUSC Alternative locations

Train general dentists in care of very young and those with special needsLicensure by credentialsIncrease in-migration of DMD’sIncrease RDH’s

Workforce Report: Target Under Served Populations

Maintain increase in Medicaid ratesReduce Medicaid admin. proceduresIncrease NHSC DMD’sEstablish practices in Community and Public Health sitesFinancial incentives to young DMD’sExpand and strengthen volunteerismIncrease diversity of workforce

Medicaid

Data1.2 M children <21(1999 est.)441,000 Medicaid (and CHIP) “eligible”28,500 potentially “eligible”35% public school students eligible46% children Reduced/Free Lunch Program28% any dental service FY 200025% preventive dental servicePresent expenditures exceed increases in access

Medicaid Program Improvements

Fee increase to 75th percentileNo prior authorizationADA codes and forms standardizedCodes for medical and behavior managementReduced required information to 8 fieldsNo provider signature required“Pay and chase”Family Support Services

Dental Public Health Programs (local level)

Allendale AliveAnderson/OconeeCatawba HDSmiles for a LifetimePalmetto HD PartnershipApp. III HD School projectMUSC

Commun-I-CareHealth ReachTechnical CollegesWomen’s ShelterVols. In MedicineReligious GroupsGreenville Free ClinicHPS School Program

Summary

SC recognizes oral health disparitiesInitial steps to addressBudgetary and programmatic challengesStrategies to increase access