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Oral Health: Access for the Uninsured and Underserved Community Voices Miami

Oral Health: Access for the Uninsured and Underserved Community Voices Miami. Oral Health Dialogue October 15, 2007. Oral Health and Miami-Dade County. Benchmarks and Goals Dental Provider Capacity Strategic planning efforts Local initiatives Medicaid program in Miami-Dade.

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Oral Health: Access for the Uninsured and Underserved Community Voices Miami

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  1. Oral Health: Access for the Uninsured and UnderservedCommunity Voices Miami Oral Health Dialogue October 15, 2007

  2. Oral Health and Miami-Dade County • Benchmarks and Goals • Dental Provider Capacity • Strategic planning efforts • Local initiatives • Medicaid program in Miami-Dade

  3. Oral Health: Overview • FHIS Study Update • 650,000 people uninsured in Miami-Dade • 120,000 are children • Dental Caries (cavities) is 5 times more common that childhood asthma • Less than 26% of people (mostly children) with Medicaid went to a dentist in 2005 • 300,000 children with Medicaid in Miami-Dade

  4. Oral Health: Community Assets • Safety net providers committed to improving health outcomes • Inventory of oral health services • Analysis of best practice models • Strategic plan for oral health • Miami-Dade Community Health Report Card • Community interest • Funders’ interest

  5. Healthy People 2010 • Health objectives for the Nation to achieve over the first decade of the new century • Used by many different people, States, communities, professional organizations, and others to help them develop programs to improve health  • Managed by U.S. Dept of Health and Human Services

  6. Healthy People 2010: Oral Health 21-1. Reduce the proportion of children and adolescents who have dental caries experience in their primary or permanent teeth. 21-8. Increase the proportion of children who have received dental sealants on their molar teeth.

  7. MDC Community Health Report Card • Analyzed 93 health indicators in eight general areas of well-being • The Report Card asks: How well are systems and institutions meeting resident needs?   • Grades are given as a call to action for policy makers and other stakeholders • Oral health was in the bottom 20 health indicators and received and “F” • 10.1% disparity between Hispanics and non-Hispanics for annual dental visits of children ages 2 - 17

  8. Oral Health: Assessing the Need • Oral Health Providers in Miami-Dade • Community health centers • Hospital-based providers • School-based providers • University satellites • Volunteer organizations • Others serving Miami-Dade (Medicaid providers)

  9. Access to Oral Health In Miami-Dade County… + 650,000 uninsured = 2.2 million with 560,000 that rely on public health insurance 302,500 seeking a dentist (assuming 25% utilization rate)

  10. Dental Provider Questionnaire: Findings • 21 provider sites surveyed • Collectively, 53,985 patients seen per year (based on 2003 data) • 59% Uninsured patients • 19% Medicaid patients • 80% of centers see predominantly patients in the lower income range • 72% base their charges on a sliding fee scale based on income

  11. Dental Provider Services Average of services provided: • cleanings (25%) • X-rays (21%) • fillings (27%) • extractions (10%) • specialty (9%)

  12. Dental Provider Capacity • Waiting time for a regular visit to the dentist ranges between 1 and 20 weeks • All centers providing emergency services answered no waiting time in the case of an emergency. (5 do not provide ER services)

  13. Dental Provider Questionnaire: Findings • When asked to select policy measures that would help improve access to dental care, the majority pointed to changes in Medicaid. • Others felt that through educating patients about the importance of oral health, keeping appointments and continuity of care, outcomes would improve.

  14. Dental Provider Funding Federal sources: • 16% of respondents marked Medicaid as their main source of income (Miami Children's Hospital and JHS North Dade Health Center) • FQHC are eligible for federal funding through their designation as Dental Health Professional Shortage Areas (HPSAs). Providers might not be able to fully utilize this funding.

  15. Strategic Planning • Strategic Plan for Improving Oral Health for the Uninsured and Underserved in Miami-Dade County 2005 • Goal: Improve oral health outcomes for the uninsured and underserved in Miami-Dade County • 7 Recommendations modeled after the State Oral Health Improvement Plan

  16. Strategic Plan: Local Initiatives • DOH Consortium for a Healthier Miami-Dade formed an Oral Health Committee in 2005. • Reviews Strategic Plan to determine which activities can be implemented • Give Kids a Smile, Miami • Oral health providers and volunteers to screen and treat children identified as not otherwise having access to dental care.

  17. Strategic Plan: Local Initiatives • Community health centers • Miami Beach Children's Oral Health Initiative • Mobile Vans • Department of Health • Miami Children’s Hospital • Homeless Trust • PATCH (UM)

  18. Medicaid & Access to Oral Health Why focus on Medicaid? • Patient utilization rates are low • The program is not utilized to its potential • Dental providers need appropriate compensation for providing care • Could be a sustained resource allocation • Medicaid reform is the contextual reality

  19. Medicaid & Access to Oral Health Nationally… • More than 90% of dental healthcare is financed through private sources (Surgeon General Report, 2000). • Less than 5% of dental care costs are financed publicly, mainly through Medicaid. • These policies affect oral health outcomes for people who do not have insurance or who are enrolled in Medicaid.

  20. Medicaid & Access to Oral Health In Miami-Dade County… • 24% of Miami-Dade population covered by Medicaid versus 16% state average in Florida • Population highly vulnerable to oral health disease and with poor access to dental care services • Income and education per capita are lower in the county than in the rest of Florida and the U.S.

  21. Medicaid & Access to Oral Health In Miami-Dade County… • Approximately 300,000 children in Miami-Dade are enrolled in Medicaid • Approximately 1 in 4 children enrolled in Medicaid visit a dentist per year • Data for uninsured children is not available.

  22. Medicaid & Access to Oral Health In Miami-Dade… • 2004: Florida legislature approved managed care pilot for Medicaid oral health services in Miami-Dade County. • Capitated monthly rate under Medicaid oral health pilot $4.28 on average or $51.36 per year. • For that amount, basic services such as an exam, x-rays, cleanings, fluoride and sealants. • Monthly rate is paid whether or not patients are treated. • Columbia University analysis (2006) showed: • State costs stayed the same while utilization of services along with other measures of quality and declined so the value of state dollars decreased

  23. FOR MORE INFORMATION Community Voices Miami 305.377.4484 150 SE 2nd Avenue, Suite 709 Miami, Florida 33131 www.communityvoicesmiami.org www.collinscenter.org Community Voices Miami is a project of the Collins Center for Public Policy, Inc.

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