How Central Massachusetts Increased Access to Oral Health Care for Low-Income Children
February is National Children’s Dental Health Month, so the Human Capital Blog reached out to John Gusha, DMD, PC, a 2003 Robert Wood Johnson Foundation (RWJF) Community Health Leader, to learn more about children’s oral health. As project director of the Central Massachusetts Oral Health Initiative, Gusha mobilized dozens of dental societies and non-profit groups to provide dental care for low-income residents of Worcester County. Although funding for the Oral Health Initiative has ended, many of the programs Gusha helped create are still in place.
Human Capital Blog: What spurred the Central Massachusetts Oral Health Initiative? What made you aware of this need for oral health care in your community?
John Gusha: There was a special legislative report in 2000 that described disparities in access to oral health care for low-income populations. It raised a lot of questions about what we could be doing in the community and in the dental society to address these gaps. We got funding from the Health Foundation of Central Massachusetts, which also saw this as a critical need for our area, to launch the initiative.
HCB: Tell us about the school-based programs you put in place.
Gusha: The decay rate in Worcester County schools was very high—more than one-third of the students had active decay in their mouths. It was especially prominent in schools with high numbers of free and reduced price lunches, where students came from low-income families that are more likely to be using Medicaid. These students didn’t have access to care and weren’t getting the preventive services they needed.
We started a school-based program that is now in place in more than 30 Worcester County schools. Dental hygiene students from a local community college provide fluoride varnishes, cleanings and other preventive services to students, and the University of Massachusetts’ Ronald McDonald “Care Mobile” visits schools to offer the same services. Community health centers also participate in these programs by adding dental to their school-based health centers. In the past you could go to schools and provide services, but Medicaid rules didn’t allow you to get reimbursed. We were able to help get those rules changed so the program could become sustainable.
HCB: You also had a role in creating a dental residency program and training primary care providers to screen for oral health needs.
Gusha: We wanted to better integrate dentistry into medicine. The University of Massachusetts was the administrator of our program, and the team there developed a dental residency program at the medical school. The University had no classes in oral health before this. The local hospitals were in desperate need of professionals with this kind of training, particularly in emergency rooms. The Medicaid population was presenting there frequently for treatment because they had nowhere else to go, and people with other issues like cardiac problems or cancer needed clearance on their oral health in order to proceed with treatment.
The residency program is still in place at our two local community health centers, and it’s grown now to include education for other disciplines.
For instance, there are programs to educate pediatric physicians to apply fluoride varnishes, and for nurse practitioners to do oral exams and provide preventive services for young children during check-ups.
HCB: What else did the Initiative include?
Gusha: We tried to tackle the issue from several different directions. We focused on volunteerism—getting dentists to voluntarily take on Medicaid patients. At that point less than five percent of dentists participated in Medicaid programs; now we’re over 50 percent. This big push on volunteering also helped spread the word that there was a problem that needed addressing. It served an educational purpose and spurred discussions at every regional dental society meeting that encouraged even more dentists to participate.
We also worked with the state legislature to improve Medicaid funding and reimbursements. We got the state to stop running the program and give it to a third party administrator, which made it easier for dentists to bill and receive payment for their services because they could use systems they already had in place in their offices. That raised the number of Medicaid patients dentists were willing to take on. The state also approved funding for adult dental benefits under Medicaid, which had not previously been covered.
HCB: There’s no doubt the RWJF Community Health Leaders award was well-deserved! How did you feel about receiving that award?
Gusha: It’s difficult for the leader of an organization to accept an honor like that because it’s not just me—there are so many people working on the problem. But it was a tremendous honor, and certainly one that opened doors for us to be able to voice our cause. Being recognized by RWJF brought us credibility when we went before our state legislators and congressional leaders.
Read more about RWJF's commitment to oral health and the work of some of its grantees working to improve oral health care.