Photo credit: Community Catalyst Dental Access Project
These are scary and uncertain times. The novel coronavirus (COVID-19) has exposed the many holes in our health care delivery and other social safety net systems. Unfortunately, the communities struggling most to access testing and treatment for COVID-19 are many of the same communities hit hardest by the economic impacts of this virus and who struggle to access the oral health care they need. As many advocates shift focus to protecting the physical, emotional, and financial health of their communities, we know that the need for access to critical dental care has not gone away.
Even before COVID-19, millions of people struggled every day to access oral health care, living with pain and unmet need. For those without adequate dental coverage and access to care, community health centers, federally qualified health centers and hospitals are often the only available sites of care. Many of these sites have been overwhelmed by, and have had to make changes to their care delivery models in light of, COVID-19, limiting people’s access to routine dental and other essential care there.
And, once this acute public health crisis abates, the longstanding dental care crisis will remain.
Because of this, we must stay vigilant. Fortunately, we know that oral health advocates across the country already have been fighting for a more just dental delivery system. In this unique moment, we have the opportunity to transform a system that has historically left many without access to the oral health care they deserve. Now, more than ever, we need to invest in innovative ways of delivering care. Below are several policy options to consider as you balance public health response to COVID-19 and advocacy for a robust, affordable and respectful dental delivery system – to respond to this crisis and to carry us forward toward a future with oral health equity.
- Universal and comprehensive dental coverage: Oral health is health. Everyone deserves access to the full range of health services they need, including comprehensive oral health care, in the wake of COVID-19 and beyond. In order to access care, people first need a way to pay for it. Medicare should include a comprehensive dental benefit and full dental benefits for adults should be mandatory in Medicaid and included as an essential health benefit in private Marketplace plans.
- For now: When state revenue streams are under pressure, as they are now due to the economic impact of COVID-19, optional Medicaid services like adult dental are often the first to get cut. Advocates should push back against short-sighted measures like this; while the intent is to save money in the short-run, such cuts will lead to greater oral health problems in the future and may cost states more in the long-run.
- For the future: COVID-19 has necessitated planned delays in the provision of non-emergency dental services. This means that future demand for routine care will only increase. Universal, comprehensive dental coverage will ensure that, once it’s safe to do so, people can access care without worrying about cost.
- For now: When state revenue streams are under pressure, as they are now due to the economic impact of COVID-19, optional Medicaid services like adult dental are often the first to get cut. Advocates should push back against short-sighted measures like this; while the intent is to save money in the short-run, such cuts will lead to greater oral health problems in the future and may cost states more in the long-run.
- Expand the dental workforce: To ensure access, we must ensure everyone has a way to pay for care and that there are enough providers to meet the need. With more than 56 million people living in dental health professional shortage areas, our dental workforce isn’t sufficient to meet current need and won’t be nimble enough to expand in the wake of increased need post-COVID. Authorizing dental therapists, expanding the scope of dental hygienists, and ensuring that all members of the dental team can work at the top of their license will ensure we have the oral health workforce necessary to meet everyone's needs.
- For now: In the wake of the COVID-19 pandemic, the dental delivery system will need more providers to meet the increased demand for care and to ensure people can use their coverage. Dental therapy is cost efficient and allows clinics to serve more patients without additional funding from the state. As state budgets are strapped, this offers an opportunity to conserve funds, while still expanding access to care. Dental therapy also allows communities to locally train and hire providers, promoting equitable distribution of the dental workforce. In times of crisis, this helps more communities have locally-based providers and limits peoples' need to travel for care.
- For the future: Paired with universal and comprehensive dental coverage, an expanded dental workforce, including full authorization of dental therapists, will help create a future where everyone can access the dental care they need, when and where they need it. Dental therapists offer the additional benefit of providing community-based care and building a dental workforce that is representative of the communities it serves
- Improve access to and increase payment for tele-dentistry services: Use of tele-dentistry methods, like video appointments and text communication, offer people the ability to be evaluated and to get expert advice from their provider without needing to leave their home or make it to a clinic or dental office for an appointment. In combination with universal, comprehensive coverage and the availability of community-based care by dental therapists, tele-dentistry can be part of a robust dental delivery system that meets people where they are.
- For now: In light of recommendations for dental providers not to offer non-emergency care amidst the COVID-19 pandemic, many people can’t get the routine care they need. Tele-dentistry would allow people to access evaluation and get advice for at-home care until it is safe to receive care in a clinic or dental office. Many state Medicaid programs may be able to authorize coverage of tele-dentistry services immediately given the current public health crisis.
- For the future: Widespread public health crises are not the only, or even most common, barrier that limit peoples’ ability to get to a dental appointment. Lack of providers in a community, lack of accessible transportation, inability to pay for care, among other social determinants, create barriers every day. Even after the COVID-19 pandemic has waned, expansion of tele-dentistry services, especially when paired with authorizing dental therapists, can expand the reach of the delivery system and help more people get access to timely care.
These are not radical solutions, but they do represent a shift in how dental care is currently provided in this country. Community Catalyst been partnering with oral health advocates for years to advocate for these and other necessary changes to the system. That won't stop now and it won't stop after we've begun to recover from this crisis.
Please see this list for additional COVID-19 related resources and guidance for oral health professionals and advocates. As always, if you or your organization would benefit from targeted support or specific resources, please don’t hesitate to reach out.