ASDA Advocacy presents Barriers to care

The facts 181 million American will not visit the dentist this year. 1 in 4 children under the age of five have dental caries. 50% of Americans over the age of 30 suffer from some kind of gum disease. As of Dec. 31, 2018, there were 5,833 Dental Health Professional Shortage Areas (HPSA). It would take 10,635 additional practitioners to meet every HPSA community's need for dental providers (a population to practitioner ratio of 5,000:1). Notes: Statistics are taken from the ADA’s Action for Dental Health Year Two: A Progress Report (2015). And Kaiser Family Foundation: https://www.kff.org/other/state-indicator/dental-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D Barriers to care can leave patients with serious conditions that threaten their overall systemic health.

What are barriers to care? Include anything that limits or prevents people from receiving adequate health care. The most common are: financial hardship geographic location pressing health needs poor oral health literacy Language, education, cultural and ethnic barriers may compound the problem. Notes: Statistics are taken from the ADA’s Action for Dental Health Year Two: A Progress Report (2015).

ASDA’s Stance on barriers to care H-1 Student Involvement to Address Barriers to Care: ASDA encourages the participation of interested dental students in efforts to impact the oral health of the public through projects, education, internships, externships and outreach to underserved populations. H-2 Evidence-Based Solutions for Barriers to Care: ASDA supports evidence-based measures that are efficacious and sustainable in reducing barriers to care in underserved communities. These measures include, but are not limited to, early intervention, Medicaid expansion and co-location of health services. Notes: The 2018 ASDA House of Delegates adopted these two policies. Delegates agreed dental students should be involved in the reduction of barriers to care and that evidence-based measures to should be employed. The ASDA House of Delegates previously adopted a resolution to help define the barriers to care issue. Delegates agreed that "barriers to care" be used rather than "access to care." 4

Supported measures to alleviate barriers to care ADA’s Action for Dental Health Initiative Community Dental Health Coordinators Preventative care and early intervention ER referral programs Teledentistry Children’s Health Insurance Program Extend Medicaid coverage of procedures Decrease student loan burden to increase dental providers Increase health service corps job opportunities for dentists in underserved areas Encourage increase participation in outreach programs such as Give Kids a Smile and Mission of Mercy Sources: https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0419_1.pdf?la=en Niodita Gupta and Marko Vujicic. Main Barriers ot Getting Needed Dental All Relate to Affordability. April 2019. Web 5

ASDA’s Initiatives: 2017 and 2018 In October 2017, ASDA sent a letter to Congress urging the House of Representatives to extend funding for the National Health Service Corps, Community Health Centers and the Childhood Health Insurance Program. In 2018, due in part to ASDA's efforts of sending more than 600 letters to Congress, the Action for Dental Health Act passed into law.  6

Action for dental health explained Amends the Public Health Service Act to authorize the Department of Health and Human Services to award grants for oral health initiatives conducted by state, local, and tribal entities, including initiatives aimed at preventing dental disease and reducing barriers to dental services. Reauthorizes and revises the grant program regarding dental health professional shortage areas, which is administered by the Health Resources and Services Administration. Authorizes states to use grant funds for: dental homes for children and adults, and initiatives that reduce emergency department visits for certain dental services. Sources/: https://www.congress.gov/bill/115th-congress/house-bill/2422 https://www.ada.org/en/publications/ada-news/2018-archive/november/action-for-dental-health-act-is-now-law 7

ASDA’s Initiatives: 2019 In April 2019, nearly 500 dental students attended the ADA Dentist and Student Lobby Day in Washington, D.C. Students spoke alongside dentists in support of the Ensuring Lasting Smiles Act, which ensures children suffering from congenital anomalies and birth defects are able to receive the treatment they need.

ASDA’s Initiatives: 2019 In alignment with ASDA’s H-2 policy, the association continues to monitor and support legislation that expands dental Medicaid benefits at the state level. Here are states current pending legislation to expand dental Medicaid benefits: S 94: provides dental benefits under Medicaid for adults in Vermont LD 519: expands Medicaid dental benefits in Maine SB 467: restores preventative adult dental benefits under Medicaid in Hawaii

Medicaid expansion explained The situation: Some states cut or don’t provide adult dental benefits in Medicaid as a cost-saving measure. As of 2019, nearly 35 states have adopted legislation to expand dental benefits through Medicaid. These expansions oftentimes include providing low-income adults with preventative dental care. ASDA’s response: The association supports evidence-based measures that are efficacious and sustainable in reducing barriers to care in underserved communities. Increasing access to preventative dental care through Medicaid expansion can reduce overall healthcare costs by lowering emergency room visits.

Medicaid expansion: A CASE STUDY In 2016, Missouri expanded Medicaid to include adult dental benefits. Since then, the state has seen a dramatic reduction in dental-related emergency room visits.  In January 2015, before the benefit was in place, the state recorded 1,439 non-traumatic emergency dental department visits (based on the number of claims). In January of 2018, 827 emergency department claims for dental visits were made, resulting in significant savings for the state.  Read more here: https://myemail.constantcontact.com/Advocacy-Brief--Three-states-vote-to-expand-Medicaid-.html?soid=1102168765265&aid=06MUcGwIfsw

What can you do to alleviate barriers to care? Many chapters participate in projects like Give Kids a Smile and Missions of Mercy to provide dental care to patients who may otherwise go untreated. Many ASDA chapters collaborate with their state associations to champion legislation that combats barriers to care. Connect with your chapter leaders to see how you can get involved or to plan an event at your chapter.

Get involved with asda to combat barriers to care ASDA’s Engage website: Has active alerts for bills that combat barriers to care. Take a few minutes today to write your congresspeople. Lists state and federal bills related to barriers to care that are being monitored by the council on Advocacy. Visit Engage to see if there’s an active bill in your state. Advocacy Brief, ASDA’s monthly newsletter is devoted to legislative updates. Attend ADA Dentist and Student Lobby Day to speak directly to the legislators that can help alleviate barriers to care. Participate in Advocacy Month each November to champion issues like barriers to care.

resources See what ASDA members are saying about barriers to care: “Using research to collaboratively address barriers to dental care”  “Encouraging long-term oral health investment in underserved communities”  "Reducing barriers to care with school-based clinics”  "Addressing patients with special health care needs” 

Organized Dentistry & Barriers to care Here are other resources on barriers to care: ADA Access to Care Webpage  AGD Access to Care White Paper  Main Barriers to Getting Needed Dental All Relate to Affordability, ADA Health Policy Institute Research Brief

Advocate for your future ASDA’s Council on Advocacy Email advocacy@asdanet.org to determine what you can do to advocate for your future. 15

Questions?