The ADA and ADSO Use Policy Reform to Expand Dental Care Access for Vulnerable Populations
Despite various programs aimed at improving dental care access for underserved populations, significant gaps remain, particularly for Medicaid beneficiaries and residents in rural areas. The American Dental Association’s Health Policy Institute, in partnership with the Association of Dental Support Organizations, recently published a research brief that proposes critical policy reforms and workforce strategies to address these disparities.
Access to dental care remains a critical issue for vulnerable populations, particularly those covered by Medicaid and residents in rural areas. The American Dental Association’s (ADA) Health Policy Institute (HPI), in collaboration with the Association of Dental Support Organizations (ADSO), published a research brief “Improving Dental Care Access for Vulnerable Populations” that identified key challenges and proposed significant policy reforms to address barriers to dental care in the United States. Despite various efforts to increase accessibility, coverage limitations and the insufficient supply of Medicaid-participating dentists have left many without necessary dental care. According to surveys, the low reimbursement rates from Medicaid and the administrative burden imposed by state programs are primary factors discouraging dentists from treating patients covered by Medicaid.
This disparity is particularly pronounced in rural areas, where shortages of dental care providers are exacerbated by the aging workforce. Although dental schools have implemented specialized programs to train students for practice in these communities, the full impact of these initiatives will take years to materialize. In the interim, the problem is likely to worsen, necessitating immediate policy interventions.
One potential solution lies in the expansion of DSOs, which provide nonclinical, administrative services to dental practices, allowing dentists to focus more on patient care. The economies of scale that DSOs can offer may reduce costs and administrative burdens, making it easier for practices to participate in Medicaid. Additionally, DSOs are increasingly popular among new dentists, with nearly one-quarter of dentists less than 10 years out of dental school now affiliated with a DSO-supported practice. This trend is particularly strong among dentists from highly underrepresented racial and ethnic (HURE) backgrounds, who are more likely to participate in Medicaid.
Efforts to diversify the dentist workforce are also seen as a crucial step toward increasing Medicaid participation. Black, Hispanic, and Asian dentists, as well as those practicing in rural areas, have higher rates of Medicaid participation compared to their white and urban counterparts. Policies that promote the racial and ethnic diversification of the dentist workforce could lead to a more robust network of Medicaid providers.
Community-based dental education (CBDE) programs are another avenue through which access to dental care in underserved areas can be improved. These programs recruit and train dental students who are interested in practicing in rural and underserved communities, offering financial aid and loan forgiveness programs to facilitate their retention and recruitment. Participation in these programs has been increasing and programs such as the National Health Service Corps is driving more primary care practitioners to underserved areas.
Licensure portability is also highlighted as a means of increasing access to dental care. The current licensure requirements, which vary from state to state, can be a significant barrier for dentists who wish to practice in different states. By adopting interstate compacts that simplify the licensure process, states can increase the pool of out-of-state providers and improve continuity of care for patients.
To further these goals, the ADA and the ADSO have supported several legislative initiatives aimed at improving access to dental care for underserved populations. The Medicaid Dental Benefit Act and the SMILED Act are two such pieces of legislation. The Medicaid Dental Benefit Act would mandate dental coverage for all adult Medicaid beneficiaries, while the SMILED Act aims to reduce the administrative burdens that often discourage dentists from participating in Medicaid. Additionally, the ADA and the ADSO are advocating for the passage of the Dentist and Dental Hygienist Compact (DDH Compact), which would streamline the licensure process for dentists and dental hygienists across state lines. Click here to read more.
