NMDA Journal Spring 2020

nmdental.org 13 continues on page 14  Medicaid Progress: Senate Memorial 96 Taskforce Report UNM Dental Residency Program The University of NewMexico Department of Dental Medicine contributes to NewMexico’s dental workforce by providing further profes- sional training and clinical experience for den- tists enrolled in its “residency program.” The mission of the residence program is to provide education and clinical programs to train den- tal health professionals in dental education, clinical services, community health, and research to improve oral health throughout NewMexico. The program’s emphasis is in pri- mary care because poor oral health has been linked to other health issues, including heart disease and diabetes. The University of New Mexico’s post-graduate dental residency pro- gram has accepted nine students this year. Historically, 64% remain in NM after complet- ing a one-year clinical program. New Mexico Dental Student Enrollment Of the 6,250 students enrolled in United States dental schools in 2018–19, only 17 were from NewMexico, while 440 were from Texas, 110 fromUtah, 82 from Arizona, 81 fromColorado, and 63 fromNevada. Of the 17 NM students, Creighton, a private school, eight were accepted. Since the year 2000, Arizona and Utah have established two dental schools each, and Nevada has established one school. Texas has three state dental schools, however, by Texas state law, the enrollment of non- resident applicants to state funded medical and dental schools is limited to 10% of the entering class. For the 2018–19 academic year, there were no NM students enrolled in Texas schools. Also, no NM students have been enrolled at the University of Missouri, Kansas City, a WICHE participating school. Analysis One of the most relevant barriers to access to dental care is high cost, and one of the reasons dental care is expensive is because of the cost of dental professional education. Dentists graduate from dental school with an average debt of $250,000, so dentists need to charge enough to pay their debt obliga- tion. Additionally, establishing a dental office can cost up to $250,000, which can raise their previous debt to $500,000. The state of NM and the Federal Government support several programs for health profes- sionals to pay down educational debt. Such programs, with some exceptions, have the primary purpose of meeting basic primary care clinical needs for those residing in Health Professional Shortage Areas, those exhibiting financial need, and in practices willing to accept all patients. Debt payment and educational support programs are important tools for recruitment and reten- tion. Additionally, the programs result in making more services available to patients, especially to those patients participating in Medicaid. However, in New Mexico several programs to support health professionals with student debt have experienced funding reductions over the last several years. Recommendations • Increase debt payment and educational support programs for oral health professionals. • Provide education and information to high school students about financial aid opportunities such as loan repayment, Western Interstate Commission for Higher Education (WICHE), NM Health Service Corps, and other educational support programs to assist with the high cost of dental education. • Professionals participating in educational support programs are required to serve Medicaid patients for at least two years after graduation. • Improve state programs in NewMexico as described below: 1. NewMexico Rural Primary Health Care Act (RPHCA) + Restore funding of $10.2 million for the FQHC program that supports salaries and benefits for non-profit clinicians; funding was reduced by 63% over the last several years. + Authorize and fund a $3 million loan repayment program allowing for New Mexico Department of Health (NMDOH) to contract with clinics to offer guaran- teed access to loan repayment. + Increase funding for each element of the RPHCA, including active recruitment of dentists and hygienists. + Assist clinics in “recruiting for retention” and developing both recruitment and retention plans. 2. NewMexico Health Service Corps (NMHSC) + Restore overall funding to the $750,000 level for Medical and Dental components of the NMHSC. + Restore the $250,000 base program funding for allocation to dentists, hygien- ists, and community-based projects. + Allow funds returned by participants and from defaults to be returned to the program, not to the general fund. 3. New Mexico Rural Health Practitioner Tax Credit Program + For rural/frontier dentists and hygienists, double available tax credits to $10,000 and $6,000 respectively. 4. New Mexico Higher Education Loan Repayment Program + Transfer the administration of the pro- gram to NMDOH/Public Health Division (PHD)/Population and Community Health Bureau/Office of Primary Care and Rural Health. » Construct the Program Advisory Com- mittee according to the defining statute: » Include oral health representation on the advisory committee and applica- tion review process. » Cease operating the program as if it is an educational program—participants are employed. » Increase funding to $5 million for the state portion of the program. » Increase individual annual awards to participants to $100,000. » Increase term of obligation from two years to five years per contract in accordance with the increased finan- cial support. » Regardless of Health Professional Shortage Area score, create a rural and/or frontier practice award of $200,000 per year with a five-year associated obligation. » Allow for half time practice and for pro-rated service time. » Clarify to applicants who have been denied renewals after the initial two- year contract period reasons for deni- als and explanations why new awards are made in their places. 5. New Mexico Higher Education Allied Health Loan for Service (RDH) + Increase aid from $12,000 to a maxi- mum of $20,000 annually. + Include oral health representation on the advisory committee and application review process.