NMDA Journal Spring 2020

12 New Mexico Dental Journal, Spring 2020 » Access Oral health is crucial for the normal develop- ment of individuals, from pregnancy to adult- hood and oral health impacts overall health and quality of life. Analysis Increasing oral health access for underserved populations will reduce oral health inequities. Increasing Medicaid enrollment is an oppor- tunity to expand access to oral health among underserved communities and to achieve health equity. There are numerous barriers that prevent access to dental care for children enrolled in Medicaid, including: • Immigration status • Lack of an understandable and approachable enrollment process • Lack of knowledge about how to navigate the health system • Provider shortages in rural areas • Geographic distance • Poor oral health literacy • Language barriers • Insufficient centers or funds to pay for day care • Parents unable to take off work during the day These barriers prevent parents from establish- ing a dental home. As a result, individuals without a dental home tend to go to hospitals/ emergency rooms for treatment when in pain, which may not resolve the need for immediate treatment. It is important to note that patients with spe- cial needs are a vulnerable population who are likely to experience poor oral health and access to dental care services. Barriers are affordability, accessibility, accommodation, and availability, which makes it more difficult to identify dental care resources. There is a lack of professionals trained to provide dental care services for special needs patients, and some of those who become trained as special needs dentists don’t provide services to this population after the training, although there is an enhancement code, D9920, that allows providers who are trained to treat individuals with developmental disabilities. The taskforce recognizes the importance of increasing access for patients with special needs. Recommendations • Improve oral health literacy and address cultural differences of Medicaid enrollees (parents and children) and in underserved communities. • Promote the importance of regular dental care by implementing/increasing school- based oral health programs that engage community members, school officials, children, and families. • Train non-dental providers (e.g. Community HealthWorkers/Promotoras) to provide oral health education at home visits. • Increase social marketing strategies to promote oral health among Medicaid- eligible and Medicaid-enrolled children. • Annually provide one million dollars to improve access to care and oral health education by increasing the number of school-based linked, or school-based centers, and/or dental clinics that can provide fluoride varnish, dental sealants, and preventive dental hygiene services to students, especially in rural/frontier New Mexico. • Allocate funds for special needs training programs to increase the number of dental professionals providing services for special needs populations (funding amount to be determined). » Cost Savings Reduce the number and cost of acute emer- gency room dental visits by Medicaid recipi- ents over time. Analysis Barriers to accessing dental care lead people to visit a dental provider only when in pain, which increases dental treatment costs for both the health systemand the patient. National organizations such as the Centers for Disease Control and Prevention, the American Dental Association, and the Association of State and Territorial Dental Directors recom- mend a focus on preventing tooth decay and other diseases as an evidence-based practice. Increased school prevention programs (dental sealants/fluoride varnish) will reduce the num- ber of elementary school aged children and adolescents with early childhood caries and decay. Preventing tooth decay will reduce the number of children that access care through emergency room visits. It is crucial to invest in preventive measures to reduce the number of emergency room visits due to dental problems. According to the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), 2018, dental cover- age for children is part of the Early and Peri- odic Screening, Diagnostic and Treatment Benefit (EPSDT). CMS states that dental cover- age must include dental care needed for relief of pain, infection, restoration of teeth, mainte- nance of dental health (provided at as early of an age as necessary), and medically neces- sary orthodontic services. It requires states to adopt a periodicity schedule specific to pedi- atric dental services, detailing the recom- mended intervals at which enrolled children should receive checkups to assure that enrolled children receive early detection and care of any dental problem. Recommendations: • Implement a pediatric dental periodicity schedule in NM, where children start checkups at age one or before if it is required as part of the EPSDT. • Increase awareness among communities and dental and medical providers on the importance of evidence-based practices to prevent dental caries, such as the application of dental sealants and fluoride varnish. • Train medical providers to promote oral health, apply fluoride varnish, and refer primary care patients to dentists, especially at FQHCs. • Increase school-based or school-linked prevention programs especially in rural/ frontier New Mexico. » Workforce Newly graduated/licensed dentists face large debt after graduation, which discourages them from practicing in rural/frontier New Mexico.  continued from page 11 UNDERSERVED COMMUNITIES FACE INNUMBERABLE BARRIERS THAT PREVENT THEM ACCESS TO DENTAL SERVICES