Ryan White CARE Act Dental Reimbursement Program (DRP) 2000 Data

Program Overview  The Dental Reimbursement Program (DRP) under Part F of the Ryan White CARE Act was intended to help accredited Dental Schools and Post-doctoral dental education programs cover their non-reimbursed costs of providing oral health care to individuals with HIV  The data illustrated here are those for which 2000 program funds were used to cover the non-reimbursed oral health services delivered during the service year  A total of 85 institutions applied for reimbursement, and their data are illustrated in these slides Ryan White CARE Act HIV/AIDS DRP 2000

Purpose  to assist in covering the rising non-reimbursed costs faced by dental education institutions providing care to individuals with HIV  to improve access to oral health care for individuals with HIV  to ensure that dental students and residents (and dental hygiene students, as of FY 2001) receive proper training in the management of oral health care for individuals with HIV Ryan White CARE Act HIV/AIDS DRP 2000

Characteristics of Applicants Ryan White CARE Act HIV/AIDS DRP 2000 The 85 DRP applicants who submitted data that are shown here are located in 28 states and the District of Columbia. Of these programs:  47 were dental schools  Institutions of higher learning that educate and train providers in the field of dentistry and provide oral health services to individuals, including those with HIV, for educational purposes  38 were postdoctoral dental education programs  Training facilities that specialize in dentistry, provide advanced education in general dentistry, or are sites of dental practice residencies

Program Attributes Several of the programs have special attributes that distinguish them from other dental programs:  Many institutions see patients with HIV at multiple sites, including hospitals, satellite sites, community network organizations.  Several institutions offer a variety of expanded services including language interpretation, transportation assistance to appointments, nutrition counseling and case management  Several target specific HIV sub-populations, such as pregnant women, substance abusers, the homeless, and the deaf and/or blind patients with HIV.  Several institutions highlight innovative programs in their application, such as satellite locations within communities, multi-lingual staff, 24-hour emergency assistance, and extended service hours.  Others have innovative community outreach to individuals with or at risk for HIV. Such outreach programs include substance abuse treatment centers, mobile dental van, and group homes.  In addition to these special attributes, several programs strive to teach students and residents to be sensitive to the needs of patients with HIV, as well as how to properly care for these patients. Ryan White CARE Act HIV/AIDS DRP 2000

Patient Characteristics  Dental Reimbursement Program applicants reported serving 28,931 individuals with HIV.  The number of individuals receiving care from dental schools (16,123) was slightly higher than the number receiving care from Postdoctoral dental programs (12,808).  Of the total number of individuals reported receiving care, 16,998 or over one-half (58.8%) were served by programs in three states (New York, California & Pennsylvania).  The largest number of all individuals, 11,681 (40.4%), received care in postdoctoral dental programs located in New York state. Ryan White CARE Act HIV/AIDS DRP 2000

Gender Distribution of Individuals Served  Overall, 19,741 or 66% of the individuals served were males while 9,741 or 34% were females.  The proportion of males and females who received care varied by state locations of these programs.  Programs in three states (GA, NY, TX) reported serving higher proportions of females, compared to the national average. Ryan White CARE Act HIV/AIDS DRP 2000

Age Distribution of Individuals Served by the Dental Reimbursement Program  Most individuals (60.3%) who received care were in the age group  Programs in DC and GA reported serving large proportions of children (35% and 30%, respectively).  Programs in Puerto Rico, TX, and UT reported serving higher proportions of individuals over 45 years (40%, 47%, and 53%, respectively). Ryan White CARE Act HIV/AIDS DRP 2000

Race/Ethnicity Distribution of Individuals Served* American Indian / Alaskan Native 0.13% (38 patients) Native Hawaiian / Other Pacific Islander 0.08% (22 patients ) Ryan White CARE Act HIV/AIDS DRP 2000

Population Groups Served  At least three out four (75%) of the patients served were from ethnic or racial minority groups  41% of the patients served were African-Americans or Blacks  The majority (89%) of the patients served were over 25 years of age Ryan White CARE Act HIV/AIDS DRP 2000

Pregnant HIV+individuals Served  A total of 127 pregnant women with HIV were served by participating institutions during the service year.  The majority (88.2 %) or 112 of these women were cared for by postdoctoral dental programs.  The majority of the pregnant HIV+ women (72.4%) were served by DRP institutions in NY. Ryan White CARE Act HIV/AIDS DRP 2000

* Since patients may receive multiple services in multiple visits, the number of service visits may exceed the HIV+ patient caseload. Ryan White CARE Act HIV/AIDS DRP 2000 Number of Visits for Various Oral Health Services *  DRP applicants provided 141,700 oral health service visits  Dental schools provided 60.1% (85,141) of these service visits and 39.9% (59,559) were provided by Postdoctoral programs  Four types of procedures (Diagnostic, Restorative, Oral surgery & Prosthodontics) constitute 69% of the total service visits provided

Ryan White CARE Act HIV/AIDS DRP 2000 Specific Uses of DRP Funds  Nearly eight in ten (74%) program applicants reported using the reimbursement funds for direct patient services  More than one-half (54%) of the DRP applicants reported using the funds for student and resident education and training

Reimbursed Vs. Un-Reimbursed Oral Health Care  Programs received full or partial reimbursement for over half (54.4%) of the patients they served.  Some programs reported much higher percentages of unreimbursed care: For example, CO-86%; GA- 87%; IL-82%; MA-86%; VA-83% Ryan White CARE Act HIV/AIDS DRP 2000 Some Reimbursement 54.4% No Reimbursement 43.8%

Reimbursed Care by Source of Reimbursement  About six in ten (59.9%) patients with some reimbursed care were covered by Medicaid (non- Managed Care).  Some programs differ markedly in the source of reimbursement for their patients.  For programs located in TX and Puerto Rico, all their patients (100%) are covered by private insurance and other insurance, respectively.  Providers located in OR, CA, and FL reported more of their patients as having Other sources of reimbursement (70%, 67%, 31% respectively). Ryan White CARE Act HIV/AIDS DRP % 2.3% 7.8% 8.9% 20.5% 59.9% Includes self pay, Public Health Trust, charity care, ADAP, RWCA Titles II & III, CBO’s, PASET and SJ AIDS programs, NY State Correction, Shelter for Women with HIV, Central VA HIV Care Consortium

Fiscal Characteristics  Total non-reimbursed oral health care costs reported by all participating Dental Reimbursement Program applicants was $16,565,900  Dental schools reported approximately $9.2 million  Postdoctoral dental programs reported approximately $7.4 million  Applicants in New York state reported the highest amount of un- reimbursed costs (about $10 million).  Applicants in each of four states (California, Florida, Massachusetts, and New York) reported more than $1 million in un-reimbursed oral health care costs Ryan White CARE Act HIV/AIDS DRP 2000

Ryan White CARE Act HIV/AIDS DRP 2000 Total Reported Cost of Unreimbursed Oral Health Care  Total unreimbursed cost increased from $14.7 million in 1997 to $16.6 million in  This increase is mainly due to increased costs reported by dental schools – from $6.9 million in 1999 to $9.2 million in 2000  Costs reported by postdoctoral programs have declined since 1998 (from $9.3 million to $7.4 million in 2000).

Other Ryan White CARE Act Funding  Close to four in ten (37.6%) participating Dental Reimbursement Programs also reported that their institutions received funding from other CARE Act programs (to support the provision of all services):  $7,169,936 from Title I  $912,374 from Title II  $1,325,119 from Title III  $89,984 from Comprehensive Family Services Program  $281,466 from Special Projects of National Significance (SPNS)  $370,779 from AIDS Education and Training Centers (AETC) program Ryan White CARE Act HIV/AIDS DRP 2000