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The lack
of access to oral health services in Missouri has reached a level that
cannot be ignored. As with many other states, Missouri faces among other
issues, a shortage of dentists, inadequate Medicaid coverage and reimbursement,
a poorly educated population about the importance of oral health, and
a lack of a local infrastructure to address these growing issues and
needs.
The Missouri
Coalition for Oral Health Access was formed to help the State policy
makers better understand and address these needs and problems.
History:
In June of 1999, the Oral Health Program of the Missouri Department
of Health and Senior Services and the Missouri Dental Association approached
the Missouri Primary Care Association, requesting that the MPCA sponsor
and organize a "Missouri Coalition for Oral Health Access."
The MPCA took on this challenge and organized the first meeting of the
Coalition in late August of 1999.
The Coalition
sponsored community meetings around the State in November of 2000 to
gain input from communities regarding dental access and issues. Meetings
were held in St. Louis, Kansas City, Poplar Bluff, Springfield, Columbia,
Kirksville, and Maryville. This effort brought attention to the problem,
as local legislators were also invited to these meetings.
The Coalition
also hosted several Oral Health Summits, including a policy forum in
February 2000, a summit in June 2000 in which Burton Edelstein, DDS,
MPH of the Children's Dental Health Project discussed oral health policy
from a national perspective, and two additional summits in November
2001 and May 2002 in which a plan to improve oral health access was
developed.
The information
gathered from the community meetings and Oral Health Summits was used
to develop a plan for improving access to oral health services. From
February 2001, to February 2002 four Coalition workgroups worked to
developed policy and delivery system recommendations which were published
and unveiled at the May 2002 Oral Health Summit. "Oral
Health in Missouri: Policy Recommendations for Prevention, Education
and Access," outlines the issues for addressing oral health
access. Those include:
| 1.
Recruitment/retention: |
Address
the current and future shortage of dental professionals overall,
and the disparity between urban and rural of dental professionals. |
| 2.
Finance/reimbursement: |
Reinstate
the Adult Dental Medicaid benefits and increase the Medicaid reimbursement
for private practice dentists to 75% of the usual and customary
rate. |
| 3. Education and Prevention: |
Address
the growing need for patient and provider education concerning dental
health issues. |
| 4.
Infrastructure: |
Address
the need to expand the dental infrastructure, most importantly the
safety net system that provides dental services to poor, uninsured
and Medicaid patients. |
Future
Plans:
Great strides have been made as a result of the Coalition's efforts,
but there is much work yet to be completed. In May 2002, the Missouri
legislature accepted the Governor's recommended cut of dental Medicaid
benefits to adults. The Coalition will work to get those benefits reinstated,
and will monitor the 2003 legislative session and provide support in
the form of written or verbal testimony at legislative hearings as needed.
The Coalition will also work to implement the programs which address
oral health access.
Dental
Hygiene Public Health Rule: In 2002 the legislature passed
SB393 allowing dental hygienists who have been practicing for at least
three years to work in a public health setting providing fluoride treatment,
cleanings, and sealants to Medicaid children without the supervision
of a dentist. Allowable public health settings are:
- Department
of Health and Senior Services;
- A
county health department;
- A
city health department operating under a city charter;
- A
combined city/county health; department; and
- A
nonprofit community health center qualified as exempt from federal
taxation under section
501 (C) (3) of the Internal Revenue Code including
a community health center that receives funding authorized
by sections 329, 330, 340 of the United States Public Health Services
Act.
2003
Legislative Platform
Insurance
and other Barriers:
Platform
Statement: The Missouri Coalition for Oral Health Access supports
the full reinstatement of the adult dental Medicaid benefits cut from
the State FY 2003 budget, and the increase of the Medicaid reimbursement
to 75% of the usual and customary rate (UCR).
The House and the Senate both cut Adult Dental Medicaid benefits.
The Department of Social Services has drafted statutory language
to cut Adult Dental Medicaid benefits, but they have not found any
legislator willing to introduce the legislation.
Systems
and Safety Net Infrastructure
Platform
Statement: The Missouri Coalition for Oral Health Access supports
the Missouri Primary Care Association’s request for state funding
for federally qualified community health centers.
All support for federally qualified community health centers through
DSS has been eliminated. The implication of both the Medicaid cuts
and the DSS cuts is that FQHCs will be forced to cut staff and providers,
services, and facilities.
Oral
Health Professional Workforce
Platform
Statement: The Missouri Coalition for Oral Health Access supports
UMKC School of Dentistry request for increased funding to support
the expansion of the oral health professional workforce in Missouri.
The Missouri
Coalition supports full funding of the Healthy Communities Incentive
Program (HCIP), a program that provides payments to primary care physicians
and dentist in exchange for practicing four years in an underserved
area.
The Missouri
Coalition supports continued funding for the Primary Care Resource
Initiative for Missouri (PRIMO), to increase internal (Missouri) recruitment
into health professions, including dentistry.
Education
and Prevention
Platform
Statement: The Missouri Coalition for Oral Health Access supports
efforts to secure funding for statewide early childhood oral health
education and prevention initiatives.
At their October
10, 2002 meeting, the Missouri Coalition for Oral Health Access endorsed
Proposition A which asks Missouri voters: “Shall Missouri law
be amended to impose an additional tax of 2.75 cents per cigarette (fifty-five
cents per pack) and 20 percent on other tobacco products, with the new
revenues placed into a Healthy Families Trust Fund to be used for the
following purposes: hospital trauma care and emergency preparedness;
health care treatment and access, including prescription drug assistance
for seniors and health care initiatives for low income citizens, women,
minorities and children; life sciences research, including medical research
and the proper administration of funds for such research; smoking prevention;
and grants for early childhood care and education?”
Membership:
At this time there are no membership fees. Organizations must simply
notify the Coalition in writing that they support the efforts and policies
of the Coalition and that they wish to join.
The
following organizations are Coalition members:
Other
links:
For more
information about the Missouri Coalition for Oral Health Access contact:
Chris
Stewart
Missouri Coalition for Oral Health Access
cstewart@mo-pca.org
573-636-4222
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