1. Health Reform… Reforming Access to Dental Care in Massachusetts
Lynn Ann Bethel, RDH, MPH Donna E. Johnson, LICSW
Massachusetts Department of Public Health

2. Objectives for Today…
1. Describe the impact of health reform and its funding for safety-net programs and on access to dental care
2. Describe a health care workforce center and the integration of oral health with primary care
3. Describe the components of a social marketing campaign to promote the state’s loan repayment program for dental professionals in order to expand workforce capacity

3. Before Health Reform
Between 500K to 600K residents had no health insurance
Reliance on Emergency Rooms
Uncompensated Care Pool ($700M)

5. Chapter 58 of the Acts of 2006 April 12, 2006
An Act Providing Access to Affordable, Quality, Accountable Health Care
Amended and Technical Corrections…
October 06-Chapter 324 of the Acts of 2006
January 07-Chapter 450 of the Acts of 2006
January 07-Chapter 205 of the Acts of 2007

6. Commonwealth Health Insurance Connector Authority
Independent “Clearinghouse”
Health Connector Board
Offers free and subsidized insurance coverage
Facilitates the purchase of private insurance plans for individuals and small businesses (CommChoice)

7. Expanded eligibility for MassHealth (Medicaid)
Free health care for residents earning less than 150% of the Federal Poverty Level (FPL)
Partially subsidized health insurance for those earning up to 300% of FPL
Requires family insurance plans to cover dependant children up to age 25
Tax Penalty for those that don’t acquire health insurance
Small business contribution ($275 per employee per year)

8. Commonwealth Care
Income-eligible adult residents who are not eligible for MassHealth (Medicaid)
Choice of 4 different insurance plans
Residents who earn below 300% of the FPL
Sliding scale premium based on income
No deductibles
Residents who earn below 150% of the FPL
No Premiums; No Deductibles
INCLUDES DENTAL COVERAGE (originally vetoed by then Governor Romney)

9. Since Health Reform’s Implementation
+ …439,000 more residents have health insurance (4/2008)
+ … Less than 3% uninsured
+ … 91% have a regular health care provider
+/- … Increase in the use of community health centers
- …Increasing number of residents having trouble paying their medical bills
16.5 in 2007 to 17.9 in 2008

11. Chapter 305 of the Acts of 2008 “Health Reform II”
An Act to Promote Cost Containment, Transparency and Efficiency in the Delivery of Quality Health Care
Section 8…Establish a health care workforce center to improve access to health care services in the Commonwealth with a particular emphasis on primary care

12. Health Care Workforce Center
Sits within the Department of Public Health’s Division of Primary Care and Health Access
Comprised of…
State Office of Rural Health
Primary Care Office
Office of Oral Health
Office of Community Health Workers

13. Mandates…
Monitor workforce trends and capacity of providers to deliver timely, effective and culturally competent care
Develop criteria for state specific health professional shortage areas
Health Care Workforce Center Advisory Council
Critical Collaborations with multiple partners

14. Insert HCWC Website Here

15. ACCESS AFTER HEALTH REFORM
Access to Dental Care
1.2 million MassHealth members
500,000+ are children
Comprehensive Dental Benefits
26% of dentists are providers
15% active providers
ACCESS AFTER HEALTH REFORM
121,396 residents living 100% below FPL were able to access dental coverage through Commonwealth Care (FY09)
7.5% of residents have unmet dental need due to cost, compared to 13.1% in the US

20. Community Health Center Dental Programs
48 Community health center dental programs and satellites
86FTE Dentists; 45 FTE Dental Hygienists
More than 25 languages in addition to English…American Sign Language
57% have trouble recruiting dentists
40% have trouble recruiting dental hygienists
142,746 unduplicated patient visits
377,577 dentist and dental hygiene patient visits

21. CHC Dental Program Survey 2009
48% MassHealth (Medicaid)
13% Commonwealth Care
23% Uncompensated Care
18% CMSP, Self-pay, Other
9% Private Insurance
31% shortage of dentists and dental hygienists were barriers to expanding

22. Massachusetts State Loan Repayment Program
Two-Year Commitment
Part A
Full-time employment at a CHC within a DHPSA
$40,000 dentists
$30,000 dental hygienists
Part B
Full or Part-time working with the Developmentally Disabled Population
Up to $30,000

23. Premise…
Enrollment in the loan repayment program is affected by the attitudes, behavior and knowledge of the dental and dental hygiene students
Need an understanding of student preparedness for treating diverse patient populations and their perceptions about individuals with special needs
Need to an understanding of their knowledge of the MSLRP

24. Goal…
Increase the applicant pool/interest in the MSLRP more than funding can provide for
Increase legislative interest to provide additional funding
Increase access to dental care for high-risk populations
Increase the CHC provider pool to allow for increased capacity

25. What the students told us…
76% never heard of the MSLRP
Main concern was finding a job that paid enough
Reasons for not applying…
Amount of money wasn’t enough
Length of commitment
Comfort level in treating special populations
Family reasons
Limited flexibility

26. Limited knowledge about CHC dental programs
Concern that CHC dental programs didn’t provide modern dentistry
Not sure what a typical day looks like at the CHC
Not prepared to see children, special populations, high-need patients

27. Communication Channels
(71%)
Internet (68%)
School website (50%)
Word of mouth (40%)
Professional Student Organization (35%)

28. When Should Students Be Contacted?
Best time…
During the first year
At the time of acceptance to school
During the third year

29. Loan Repayment. Clinical Skills. Unforgettable Experience.
help Yourself, while helping others

34. Not an Ancient Idea Working in a Community Health Center
Loan Repayment. Clinical Skills. Unforgettable Experience.
help yourself, while helping others

35. We know it’s not your time to graduate, but…
It’s never too early to start exploring your options
for loan repayment
Loan Repayment. Clinical Skills. Unforgettable Experience.
helping yourself, while helping others
For out more at our website…