Health care leaders in New Jersey have tapped several federal grants to expand oral health programs at a half-dozen community-based clinics around the state, with initiatives expected to benefit many thousands of low-income residents annually.
Three federally qualified health centers (FQHCs) will benefit from $300,000 each to expand dental infrastructure, part of $85 million in national grants announced last week by the U.S. Department of Health and Human Services; it is the first time the agency has ever dedicated funding to expand oral health capacity at these facilities, which serve patients regardless of their citizenship status, insurance status or ability to pay. In addition, they serve communities where patients have limited access to preventive dental care, let alone affordable restorative services, like dentures or implants, according to the FQHC leaders. The federal funding is designed to help address these gaps.
The money will allow the Henry J. Austin Health Center in Trenton to reconfigure unused space to create two new dental exam rooms and hire a dentist and a part-time oral surgeon, among other upgrades. Paterson Community Health Center will renovate a three-chair facility that is nearly two decades old, creating a modern, pediatric-friendly clinic, and hire additional dentists. Ocean Health Initiatives, with multiple sites, will focus on oral cancer — which exceeds the statewide average in that county — and plans to purchase new screening equipment, upgrade its computer technology, and expand training so that more patients are tested for oral cancer risks, among other things.
“This will at least allow us to increase our primary care services,” said Mary Garner, CEO of Paterson Community Health Center. “Everything that’s beyond primary care we still have to refer out” to other oral health providers, she added, something that is needed for roughly 30% of the patients the center treats.
Greater access to high-quality, preventive oral health
In addition, the state Department of Health — which appointed a full-fledged dental director in July, the first in 30 years — said it is using a separate $1.6 million in federal funding, over four years, to address oral health and nutrition at three other FQHCs. This program involves facilities that serve patients in central and South Jersey, and Lakewood, in Ocean County; it has already screened some 1,200 individuals and enrolled 300 for additional services, DOH said.
Dr. Darwin K. Hayes, the state’s dental director, said the new federal grants for dental infrastructure are “a key component” of DOH’s goals for oral health. “The funding will expand access to high-quality, preventive oral health services to more residents — especially those of our most vulnerable, including the uninsured and under-insured,” he said.
Hayes praised the role New Jersey’s two-dozen FQHCs — with 137 sites around the state — play in providing dental services, in addition to medical and behavioral health care. According to the New Jersey Primary Care Association, which represents the FQHCs, some founded five decades ago, these facilities hosted some 376,500 dental care visits last year. (The association itself will celebrate its 30th anniversary at a conference this week).
“They are treasured assets in their communities, and that’s why the Murphy administration has committed $32 million to reimbursing FQHCs for both the oral health services and other medical care they provide to tens of thousands of vulnerable New Jersey residents each year,” Hayes said.
Benefits of federally qualified health centers
FQHCs are unique because they accept Medicaid, unlike many dentists, and can also create individualized payment plans based on a family’s earnings, clinic officials explained. (Medicaid pays for preventive oral health care and some other services in New Jersey, but many insurance programs — including Medicare — provide limited, if any, dental coverage.)
“That is the one way in which we are hugely different from other institutions. Our payment scales are based on the income of the patients who walk through our doors,” said Dr. Kemi Alli, CEO of Henry J. Austin in Trenton.
The facility served at least 5,000 dental patients last year, she said, and hopes to be able to treat another 1,500 after the expansion. The construction at Henry J. Austin will also involve the proceeds of a $117,000 grant the clinic received for addressing HIV and a $70,000 loan obtained for the project.
Nationwide, there is a growing awareness among policy experts that oral health is critical to an individual’s well-being; healthy teeth are more than just a pretty smile, dentists note, as they enable people to eat fiber-rich foods that are critical to their overall health. Deteriorating teeth and gums can lead to pain, infection and chronic health problems that force kids to stay home from school and parents to miss work.
But the FQHC leaders said more must be done to expand access to dental care, including dentures or implants. “On one hand, we downplay the role of oral health and having teeth that are functional, but on the other hand, we look down on people who have missing teeth,” Alli noted. “The day in which every payer covers preventative and restorative oral health — that’s the day we know we’ve achieved oral health parity.”
Oral health challenges in NJ
One particular challenge for New Jersey has been the limited reach of fluoridated water, which is available to less than 15% of the state’s communities, leaving the Garden State at 49th nationwide for fluoride coverage, reports suggest. The state is also one of 17, according to federal officials, that does not have a comprehensive oral health plan.
But DOH said that is due to change soon. Hayes and his team are talking to oral health stakeholders in an effort to assemble an advisory committee that can help the state develop this blueprint for better care. The hope is to hold the committee’s first meeting in early 2020, according to the department.
Months before Hayes was hired (the program had been coordinated by a nurse practitioner for years), DOH officials said it began work on the Oral Health Nutrition and Obesity Program, which targets families with children between ages 6 and 11 who are overweight.
Working with leaders at Zufall Health, based in Dover in Morris County; Complete Care Health Network, which serves Cape May, Cumberland and Gloucester counties; and CHEMED, or the Center for Health Education Medicine and Dentistry, in Lakewood, the program has aimed to help hundreds of families better understand the connections between healthy eating and lower weight, better teeth and less disease in general.
Another federal grant has enabled DOH’s oral health program to work with Rowan University’s School of Osteopathic Medicine to create a new training curriculum for Garden State dental students, with a focus on reducing opioid prescriptions, state officials said. Dentists are one of the leading prescribers of opiates, especially for young people.
Just last week, the Rutgers School of Dental Medicine received an $11.7 million, multiyear grant to coordinate with four other academic centers on a study of opioid alternatives for treating dental pain.