Safety Net
What is the dental safety net?
The dental safety net includes facilities, providers, and payment programs to support dental care for underserved populations. In Florida, as nationwide, safety net providers are a source of dental care for Medicaid (and uninsured) patients who do not have access to private providers. Workforce needs in Florida are an ongoing challenge to staff safety net institutions.
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How many private-practice dentists have publicly insured patients in their care in Florida and Palm Beach County?
Overall, 90% of dentists in Florida are in private practice and fewer dentists are taking Medicaid each year. In Palm Beach County, an standardized phone survey to 323 of the County’s 337 general, pediatric, and orthodontic practices seeking a dental appointment for a child in Medicaid indicate that 7 of 285 general dentists (2%), 5 of 29 pediatric dentists (26%), and 4 of 33 orthodontists (12%) accept a new Medicaid-insured child as a patient. Overall, only one-in-1 primary care dental practices in Palm Beach County accept children with public insurance coverage. Even if every general and pediatric dentist in the County were to participate equally in Medicaid and CHIP, each would need to serve approximately 200 more school-aged children.
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What public facilities offer dental care to underserved populations?
A comprehensive list of safety-net clinics can be found at Project Dentist Care.
44 of 67 County Health Departments (CHDs)
41 Federally-Funded-Federally Qualified Health Centers + other Community Health Centers (CMCs)
School-based School Health Centers
Dental Schools and Dental Hygiene Programs –
- University of Florida College of Dentistry
- Statewide community based clinical learning opportunities for dental students and residents that links to underserved populations
- Owns and operates 5 clinics and is affiliated with 10 other dental clinics (services are not free but offered at 50% of private-practice cost
- Southeast Center for Research to Reduce Disparities in Oral Health
- Participates in Gives Kids a Smile (see private safety net)
- Nova Southeastern School of Dentistry
- Operates 2 dental clinics for locally underserved populations
- Operates 4 portable dental units
- Partners with local community organizations for patient referrals
- Conducts program to provide preventive dental care and home care education and routine restorative care for children ages 5 – 18
- Screens patients for services that may be available to them from federal and state programs
- Dental Hygiene School Clinics at Valencia Community College and Daytona Beach Community College
- Emergency Care in Hospitals as a dental safety net provide only emergency relief of pain and infection without any definitive care.
Steps to Obtain Coverage:
- Steps for Floridians to access Medicaid are at:
- Steps to Floridians to access Florida’s KidCare
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What other private or voluntary activities of dentists support the dental safety net?
- Project: Dentists Care (PDC) was established and is supported by the Florida Dental Association (FDA) to coordinate dentists who volunteer their time and services to provide a safety net of preventive and restorative dental care to those in greatest need.
- Information for Providers [cross linked]:
- Florida Department of Health’s Volunteer Health Care Provider Program allows private licensed dentists and dental hygienists to volunteer their services to the medically indigent residents of Florida with incomes at or below 200% of the Federal Poverty Level. Through contracting with the state, a dentist or dental hygienist can become an "agent of the state" and gain sovereign immunity for providing uncompensated dental services to eligible clients. Providers have the option to volunteer in freestanding clinics or to see eligible clients in their private offices or corporate facilities. This program provides sovereign immunity, workers’ compensation, and the opportunity to earn a biennial licensure fee waiver by providing substantial pro-bono care. (See Florida Statutes Section 766.1115 and Florida Department of Health: Volunteer Health Services Program )
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What federal programs support Florida’s safety net and what other federal options are available?
Federal support to Florida through legislation and grant programs includes: Collins-Feingold Safety New Improvement Act; 2009 American Recovery and Reinvestment Act (ARRA); Children’s Health Insurance Program Reauthorization Act (CHIPRA); and Affordable Care Act (ACA):
- Collins-Feingold - An act to improve dental workforce for underserved populations for which Florida applied and received funding
- ARRA – Florida received $81,388,246 in Health Center Stimulus Awards and, as of Feb 2010, has seen 38% of its uninsured patient target (specifics about dental not identified) (National Association of Community Health Centers, Feb. 2010).
- CHIPRA provides new tools and fiscal incentives to enroll eligible uninsured children in Medicaid and CHIP.
- At passage (2009), Florida met the dental coverage requirement, but not the requirement for dental-only supplemental coverage.
- Florida has been chosen by the Centers for Medicare and Medicaid Services (CMS) to partner with Illinois to receive approximately $11.3 for KidCare in Florida to help guide CMS’ establishment of a national child quality system. From 2010 to 2015, the CHIPRA quality grant will fund Florida and Illinois activities to: 1) experiment with and evaluate the use of quality measures for children's healthcare (CMS Category A); 2) promote the use of Health Information Technology in measuring and improving children’s health (Category B-workgroup combined with A); support and evaluate innovative, provider-based models (medical homes) for delivering children's health care (Category C); and implement a quality improvement collaborative focused on improving perinatal and early childhood healthcare (Category E).
- Among other provisions, CHIPRA also clarified the option to increase access to FQHC dental services through public-private partnerships.
- Among other provisions, CHIPRA also clarified the option to increase access to FQHC dental services through public-private partnerships.
- Support services (translation, transportation, appointment making assistance) qualify for 75% federal share in Medicaid.
- ACA – Authorized and appropriated provisions include:
- Funding for Community Health Centers
- Funding for National Health Service Corps*
- Capital expenditures for school-based health centers
- Medicaid and CHIP Payment and Access Commission (MACPAC)
- ACA – Authorized but unfunded (discretionary by year)
- Oral health prevention/education campaign (5-year)
- Demonstration grants on caries disease management
- Enhanced oral health surveillance
- Enhanced oral health infrastructure through state cooperative agreements with CDC
- Grants for school-based dental sealant programs
- Grants for demonstration/evaluation of alternative dental providers
- Grants to expand dental training
- Grants for operations and equipment for school-based health centers
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State action - Ideas identified in Florida’s State Oral Health Improvement Plan (SOHIP):
- Increase the number of dentists through licensure by credentials
- Expand dental school capacities
- Increase the number of pediatric and general dentistry residency programs
- Increase capacity for foreign-trained dentists to become licensed
- Increase reimbursement for publicly funded programs (see “Lawsuit”)
- Increase volunteerism (See “Project: Dentists Care (PDC))
- Provide incentives to treat disadvantages populations such as loan repayment and tax incentives
- Expand the scope of practice of auxiliary personnel (see Workforce)
- Utilize non-dental providers in early childhood caries prevention (see Prevention)
- Expand the use of teledentistry in public programs
- Develop recruitment program for county health departments and community health centers
- Promote models to improve productivity
- Develop and promote dental care periodicity schedules for publicly funded programs
- Coalition-building activities include: Florida Surgeon General's Ad Hoc Committee, HRSA Workforce Workgroup and other efforts.
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What State Action and Best Practices support the Dental Safety Net?
- State analysis (and direct links) to state oral health plans can be found in the Children's Dental Health Project (CDHP) State Oral Health Plan Comparison Tool.
- ASTDD Workforce Development Best Practices includes multiple models & approaches.
- For 2009-2010, see:
- Other state activities:
- Demonte Driver Project (Maryland) is building a workforce of private practice dentists who accept Medicaid.
- Public-private partnership (South Carolina) that establishes private practice referrals based on a dental hygiene program in targeted schools. Results include a decline of untreated caries rates and treatment urgency rates; increase in sealant usage rates; and elimination of disparity in status of sealant use between black and white 3rd-graders.
- Foreign-educated dentists (Maryland) who completed US pediatric dentistry fellowship programs in health centers provided significant care to underserved populations.
- New York and Delaware require a minimum of one year of postdoctoral training for state licensure, increasing demand for training programs that serve the underserved.
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Where can I get more information?
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