By Karen Shih
Dental cavities are the most common chronic disease in childhood in the United States. But disparities in oral health mean these problems disproportionately affect minority and low-income children, who often have public health insurance like Medicaid and CHIP, rather than private health insurance.
Poor oral health can lead to a litany of problems. Socially, children may be shunned by peers and miss school. Economically, expensive procedures like root canals—the result of untreated cavities—can strain a family’s finances. Medically, an infection that starts with a tooth isn’t just painful—it can travel through the body, leading to brain, lung and heart problems, and even death.
State Medicaid dental programs are working on innovative ways to combat these issues. That’s what compelled former dentist Yara Halasa-Rappel, MS’06, PhD’18 to study the impact of RIte Smiles, a managed care program for children enrolled in Rhode Island’s Medicaid program born on or after May 2000. It was launched in 2006 by the Rhode Island Department of Human Services, which contracted with UnitedHealthcare.
“The state aimed to move from being a passive payer of healthcare bills to an active purchaser, to help more people have access to dental services,” she says. “The key question was, how can we increase access and improve outcomes?”
Halasa-Rappel, a senior research associate in the Schneider Institutes for Health Policy, found several factors that led to the success of the ongoing program. From its launch until 2013, it gradually increased the overall rate of patients using the dental system and shifted the age of entry into the dental system from 3 and 4 to 1 and 2. Early intervention can help providers better prevent and control diseases and build better oral hygiene practices.
She found that collaboration between various stakeholders, which included the state agency, patients, providers and dental plans, through every stage of planning and implementation was an important factor in the program’s success.
RIte Smiles included capacity building for dentists to learn how to manage the treatment of young children, offering an annual mini-residence series, and improved infrastructure and equipment for Federally Qualified Health Centers. It also included advocacy work to win over both dentists and patients, who had reservations because of misinformation about managed care’s role.
“Without these tools, managed care by itself wouldn’t have done the job,” she says.
Halasa-Rappel presented her findings at Academy Health and the New England Rural Health Round Table in 2017. She hopes they can be used by policymakers in states across the country.
“It’s obvious that different states are looking for lessons to learn,” she says. “They want to know, ‘What works? How does it work? How can we move forward in implementing change?
Now, she’s pursuing a study on how to change the behavior of Medicaid beneficiaries.
“I looked at the supply side and now I’m looking at the demand side,” she says. “We can take simple steps to better understand the barriers to access and to prevent dental diseases. We can start by asking: How can we change the concept among patients and parents that teeth matter?”