Report on Arkansas Improving Arkansans Life Quality Through Better Oral Health

Pew Report February 2010 Improving Arkansans Life Quality Through Better Oral Health The Pew Center released a study in February 2010 on access to and dental care of children in each State. Each State is graded on its policy responses to actions to improve dental health among low-income children. Their study was released with the support of the Kellogg Foundation and the DentaQuest Foundation. Two of the eight benchmarks are proven, effective means to improve oral health. Fluoridation and school base sealant programs. The other six benchmarks are Pew’s Opinion with unproven efficacy. Lack of corroboration with appropriate state officials resulted in erroneous findings for Arkansas. "We (ADA) don't agree with everything in the report," said Dr. Tankersley. "But certainly, it highlights some of the major policy areas that the ADA and state dental societies have advocated for years—things like increased Medicaid funding, school sealant programs and community water fluoridation.

The Grades A = Six States = 6 to 8 Benchmarks B = Nine States = 5 Benchmarks C = Twenty States = 4 Benchmarks D = Six States = 3 Benchmarks F = Nine States = 0 to 2 Benchmarks ***Arkansas received an “F” with two benchmarks due to use of incorrect data. AR should have received a “D” with 3 benchmarks. Improving Arkansans Life Quality Through Better Oral Health

Pew Report 8 Benchmarks  Policy benchmark #1: State has sealant programs in place in at least 25 percent of high- risk schools.  Dental sealants are recognized as one of the best preventive strategies for children at high risk for cavities. Sealants—clear plastic coatings applied by a hygienist or dentist— cost one third as much as filling a cavity. Studies have shown that sealant programs targeted to schools with many high-risk children are a cost-effective strategy—but this strategy is vastly underutilized.  Percentage of high-risk schools with sealant programs, 2009 Number of States  % 3  50-74% 7  25-49% 7  1-24% 23  None 11  Arkansas is a No. We have NO State dollars for any dental sealant program. We have partnered with ACH to increase the reach of the Seal-the-State program but still will only treat about 1,000 kids this school year. Improving Arkansans Life Quality Through Better Oral Health

Pew Report 8 Benchmarks  Policy benchmark #2: State does not require a dentist's exam before a hygienist sees a child in a school sealant program.  How many kids are served by a dental sealant program and how cost effective it is depends in part on whether the program must locate and pay dentists to examine children before sealants can be placed. Dental hygienists are the primary providers in school-based dental sealant programs, but states vary greatly in their laws governing hygienists’ work in these programs.  State allows hygienists to provide sealants without a prior dentist's exam, 2009 Number of States  Yes 30  No 21  Arkansas is a NO. This would require a policy change by ASDBE. Improving Arkansans Life Quality Through Better Oral Health

Pew Report 8 Benchmarks  Policy benchmark #3: State provides optimally fluoridated water to at least 75 percent of citizens on community systems.  A 2001 Centers for Disease Control (CDC) study estimated that for every $1 invested in water fluoridation, communities save $38 in dental treatment costs. The CDC also identified community water fluoridation as one of the 10 great public health achievements of the 20th century and a major contributor to the dramatic decline in tooth decay over the last five decades. Yet more than one quarter of Americans do not have access to optimally fluoridated water.  Percentage of Medicaid children receiving any dental service, 2007 Number of States  % 26  50-74% 16  25-49% 7  Less than 25% 2  Arkansas is currently at 64.5% up from 49% in 1999 but down from 69% in 2005 when Community Water System (Greer’s Ferry) decided to stop fluoridating its water. A State mandate is being discussed as “guaranteeing all Arkansans access to fluoridated water.” Improving Arkansans Life Quality Through Better Oral Health

Policy benchmark #4: State meets or exceeds the national average (38.1 percent) of children ages one to 18 on Medicaid receiving dental services. States are required by federal law to provide medically necessary dental services to Medicaid-enrolled children, but nationwide in 2007, only 38.1 percent of such children ages 1 to 18 received any dental care. Percentage of Medicaid children receiving any dental service, 2007 Number of States 59% or greater % % % 3 Under 30% 9 Arkansas is actually 43% according to Medicaid. Pew used outdated data producing a <38% national average. Pew Report 8 Benchmarks Improving Arkansans Life Quality Through Better Oral Health

Pew Report 8 Benchmarks Policy benchmark #5: State pays dentists who serve Medicaid-enrolled children at least the national average (60.5 percent) of Medicaid rates as a percentage of dentists’ median retail fees. Dentists point to low reimbursement rates, administrative hassles and frequent no-shows by Medicaid-enrolled patients as deterrents to serving them. In 26 states, Medicaid programs reimburse less than 60.5 cents of every $1 billed by a dentist. Even in the three states with the highest scores, children on Medicaid still lagged behind the estimated 58 percent of privately insured children who use services each year.But states are taking steps to address these issues, and as a result are seeing significant improvements in dentists’ willingness to treat children on Medicaid and in children’s ability to access the care they need. Medicaid reimbursement rates as a percentage of dentists’ median retail fees, 2008 Number of States 100% or greater % % % % % % 12 Less than 40% 4 Arkansas is a YES as AR Medicaid reimbursement rate is at 95% of Delta Dental Premier Plan rate, one of the highest in the Nation. Improving Arkansans Life Quality Through Better Oral Health

Pew Report 8 Benchmarks Policy benchmark #6: State Medicaid program reimburses medical care providers for preventive dental health services. Doctors, nurses, nurse practitioners and physician assistants are increasingly being recognized for their ability to provide children in high need with preventive dental care. Currently, 35 states take advantage of this opportunity by making Medicaid payments available to medical providers for preventive dental health services. Medicaid pays medical staff for early preventive dental health care, 2009 Number of States Yes 35 No 16 Arkansas is a NO. There are currently 42 other States allowing this and have systems for them to bill Medicaid. This would required a change to the DPA, not sure about the MPA Improving Arkansans Life Quality Through Better Oral Health

Pew Report 8 Benchmarks Policy benchmark #7: State has authorized a new primary care dental provider, 2009 Some communities with a dearth of dentists, such as rural and low-income urban locales, have little chance of attracting enough new dentists to meet their needs. An increasing number of states are exploring new types of dental professionals to expand access and fill specific gaps. In a model proposed by the American Dental Association (ADA), these professionals would play a supportive role similar to a social worker or community health worker. In remote locations, the most highly trained professionals could provide basic preventive and restorative care as part of a dental team with supervision by an offsite dentist.In 2009, Minnesota became the first state in the country to authorize a new primary care dental provider. State has authorized a new primary care dental provider, 2009 Number of States Yes 1 No 50 Arkansas is a NO. Minnesota is the ONLY state with a statute at the time of the report. ADA has 4 pilot States for CDHC. Improving Arkansans Life Quality Through Better Oral Health

Pew Report 8 Benchmarks Policy benchmark #8: State submits basic screening data to the national database, 2009 Expertise and the ability to collect data and plan programs are critical elements of an effective state dental health program. They also are necessary for states to appropriately allocate resources and compete for grant and foundation funding—all the more important at a time when state budgets are increasingly strained. State submits basic screening data to the national database, 2009 Number of States Yes 37 No 14 Arkansas is YES. The Department of Oral Health participates in the National Oral Health Surveillance System at CDC Improving Arkansans Life Quality Through Better Oral Health

Dental Education  Assistants - various levels.  Hygienists - Most 2 years, 4 year BS is optional.  General Dentists - 8 years minimum education.  Specialists – years of education. Improving Arkansans Life Quality Through Better Oral Health