1. ASDA State Workforce Review September 23, 2011 Jon Holtzee, director – State Government Affairs

2. © 2011 American Dental Association, All Rights Reserved 11 States with Frontline Activity Kellogg –Vermont –Ohio –Kansas –New Mexico –Washington Pew –Maine –New Hampshire –California Others –Connecticut –Michigan –Oregon –Missouri

3. © 2011 American Dental Association, All Rights Reserved Vermont HB 398 – creates dental therapy –Two years of education –Expansive scope –To provide hygiene must have an additional year of hygiene education –Supervision = collaborative agreement –Dead for 2011 May 6 th adjournment

4. © 2011 American Dental Association, All Rights Reserved Ohio No legislation to date –Kellogg grantee UCAHN has begun stakeholder meetings across the state and media outreach.

5. © 2011 American Dental Association, All Rights Reserved Kansas HB 2208 SB 192 –Identical bills –Creates a registered dental practitioner –18 months of education – Scope is expansive –Supervision = supervising agreement –Dead for 2011 June 3 rd adjournment

6. © 2011 American Dental Association, All Rights Reserved New Mexico HB 495 –Created dental therapists, EFDAs, CDHCs & therapy licensure for hygienists –Two years of education –Expansive scope –Supervision = dental therapy management agreement –Therapist add hygiene w/1 added year & vice- versa –Outlook for 2011 – Dead March 19 th adjournment

7. © 2011 American Dental Association, All Rights Reserved Washington HB 1310 –Creates dental therapy & advanced dental therapy –Undefined initial education for basic; advanced = hygiene license and completion of an ADHP type program –Expansive scope; advanced adds hygiene –Supervision = collaborative management agreement –Outlook for 2011 – Dead April 24 th adjournment

8. © 2011 American Dental Association, All Rights Reserved Maine LD 266 –Oral health practitioner –Minimum of 750 hrs combined classroom & clinical –Scope is expansive –Supervision = 1 year of on-site supervision, then none –Outlook for 2011 – Dead June 15 th adjournment

9. © 2011 American Dental Association, All Rights Reserved New Hampshire No legislation to date –On March 1 st, Pew announced NH as the next state in it’s dental workforce campaign –Holding a series of six stakeholder meetings –Final Report offers a “little bit for everyone”

10. © 2011 American Dental Association, All Rights Reserved California No legislation to date –The Pew Foundation is working with an organization called “The Children’s Partnership” in a California Children’s Dental Workforce Campaign to enact a DHAT-style therapy model –Other partners include the Atlantic Philanthropies, the Packard Foundation, the California Wellness Foundation, the Hilton Foundation, California Healthcare Foundation, First Focus, Verizon, the California Emerging Technology Foundation, the California Endowment and the Sierra Health Foundation. –CDA Access Report to 2011 HOD

11. © 2011 American Dental Association, All Rights Reserved Connecticut HB 5616 –Creates an ADHP “pilot” program –Education is an ADHP master’s program –Scope is expansive –Supervision = collaborative management agreement –Pilot to begin in Bridgeport on 01/01/2014 and end by 01/01/2015 –Commissioner of Social Services reports on how to expand by 07/01/2015 –Outlook for 2011 – Dead June 8 th adjournment

12. © 2011 American Dental Association, All Rights Reserved Oregon SB 227 –Creates dental therapy Education – must have a hygiene license; other certification requirements undefined Expansive scope Supervision = collaborative management agreement –Outlook for 2011 – Held SB 738 –Provides OHA with authority for pilots on workforce and education pathways, CDHC, modifies Limited Access Permit Hygiene to Expanded Function Hygiene. –Outlook for 2011 – Signed into law on August 2, 2011. June 30 th adjournment

13. © 2011 American Dental Association, All Rights Reserved Michigan No legislation to date –A faculty member from the Univ. of Michigan School of Social Work is engaging stakeholders to foster a therapy model –MDA worked with the individual and co-hosted a conference on Barriers to Care in August.

14. © 2011 American Dental Association, All Rights Reserved Missouri No legislation to date Dentist on the Dental Board advancing Minnesota style therapy program Greater Springfield Dental Society petitioned the Board to adopt therapist May 27 th DOB endorsed therapist & ADHP for Governor to add to 2012 legislative agenda

15. © 2011 American Dental Association, All Rights Reserved Dental Care Delivery in the United States 182,000 practicing dentists (IOM, 2011) –82% are primary dental care providers (149,000) 79% general dentists 3% pediatric dentists –93% in private practice Of those, 90% are small practices with 1 or 2 dentists Anticipated growth of 16% between 2008 – 2018 (BLS) 130,000 practicing dental hygienists –Most work as independent contractors or salaried employees in dentists’ offices –51% work part-time Anticipated growth of 36% from 2008 - 1018

16. © 2011 American Dental Association, All Rights Reserved Workforce Issues Size/number of providers Distribution Scope of practice Supervision Capacity/productivity Composition –Mix of providers –Characteristics (ethnicity, gender, etc.) Competencies (including cultural) Participation in public programs Delivery sites Funding

17. © 2011 American Dental Association, All Rights Reserved Size/numbers of providers Often look at simple numbers –Growth of dental education End of the era of schools closing Existing schools increasing capacity New schools opening consistently; 9 between 1997 & 2011 –At least 8 other locations are developing or considering –BLS estimate of 16% growth by 2018 –PPACA impact – Medicaid numbers not large, exchange impact could be

18. © 2011 American Dental Association, All Rights Reserved Scope of Practice A balance of comprehensive and analytical knowledge, technical ability, patient protection and politics

19. © 2011 American Dental Association, All Rights Reserved Supervisory Relationships One of the primary issues concerning dental workforce policy Semantics is a stumbling block Used to fully integrate the dental team Subject to review

20. © 2011 American Dental Association, All Rights Reserved Public Programs & the private sector No set of numbers will work if no one accepts public programs Private sector must be part of the solutions – it’s where the capacity exists –Medicaid –CHIP –Other programs

21. © 2011 American Dental Association, All Rights Reserved Medicaid Snapshot Percentage of Low-Income Children Receiving Dental Services, State by State –Pew Center on the States, The State of Children’s Dental Health: Making Coverage Matter, May, 2011 Between 2000 and 2009, only two states (FL and OH) saw the percentage of children receiving dental Medicaid services decline National increase 14% from 29.8% to 43.8%

22. © 2011 American Dental Association, All Rights Reserved Service Delivery Sites Traditional model of small offices –Works well for most, but not all To extend beyond today, services need to be taken to where patients in need are –FQHCs –Mobile –Non-dental professionals –Unique opportunities –Integration of Care

23. © 2011 American Dental Association, All Rights Reserved Funding The largest barrier to care Public programs traditionally underfunded and at greater risk today Public Health infrastructure for oral health too often ignored Decline in funding for programs like the Dental Lifeline Network – Donated Dental Services Resources ineffectively shifted to EDs

24. © 2011 American Dental Association, All Rights Reserved Last Slide Workforce and access are multi-factorial issues that are not simple Tangible solutions vary by people being served, location, need and resources If a hammer is the only tool, then only a hammer is used. That doesn’t work