This article is part of State of Health, a new series examining health disparities, how they affect Michigan's children and seniors, and the innovative solutions being developed to address them. It is made possible with funding from the Michigan Health Endowment Fund.

Julie needed dental care to get her customer service job at Home Depot back.
 

Home Depot employees greet customers with "Can I help you find something?" But without front teeth, Julie was unable to say "find" clearly and kept substituting other words. Finally, she was demoted to the store room, where she had no contact with customers and got paid less per hour.

When she tried on her dentures for the first time, she said, "Can I help you find something?" and burst into a huge smile. Julie got her customer service job back.
 

Julie's story, as shared by the Michigan Oral Health Coalition (MOHC), is not the only one of its kind. MOHC reports that dental care access is "limited or nonexistent" for nearly one million Michigan residents.

According to the 2020 Michigan State Oral Health Plan (2020 Oral Health Plan), prepared by MOHC and the Michigan Department of Health and Human Services, low socioeconomic status is a key factor in that disparity in care. Two populations that are currently experiencing significant impacts are children and seniors. But a variety of organizations across the state are working to connect people like Julie to oral care they otherwise might never get, and they're innovating to continue improving oral health access in the future.

Access changes and ongoing challenges

Throughout the last decade, access to oral health care services has undergone significant changes. That's thanks in part to the rise of a nationwide network of oral health coalitions like MOHC. Based in Lansing, MOHC seeks "to not only increase access to care but to improve policy, based on data," according to executive director Karlene Ketola.

MOHC was formed in 2003 in response to the state's elimination of the Medicaid adult dental program due to budget constraints. Initially funded by a Center for Disease Control Oral Health Infrastructure Grant, Ketola says MOHC served as the "impetus to bringing stakeholders together throughout the state (who were) looking at improving oral health."

Ketola says that was the first time Michigan stakeholders who were not dental professionals came together to focus on oral health improvement. They included insurance companies, Head Start and early education professionals, and medical professionals. Through diligent work and commitment, these partners have been able to gather data to help not only identify needs but to begin developing plans to address them.

Another fairly recent major development in Michigan oral health care access was the introduction of Healthy Kids Dental (HKD) in 2000. Starting as a pilot program, HKD had a goal of moving the administration of Michigan's children's Medicaid dental program over to a private insurance administrator, Delta Dental.

"It really eliminated a lot of the barriers," Ketola says. "Payment rates increased ... (and payments) for services rendered were quicker. It helped engage private dentists to see Medicaid children."

HKD program has slowly been rolled out to all Michigan counties, and Ketola says the program's biggest challenge now is raising awareness of just how accessible dental care is for Medicaid-enrolled children.

"Typically there's a dentist within 10 miles that they would be able to see," she says. "The program is there. The beneficiaries are there. The providers are there."

However, that increased access for Michigan kids also helps to illustrate ongoing challenges in oral health care access for the state's adults. Ketola says there's a serious shortage of Medicaid dental providers.

"If providers have signed up and are committed to the Medicaid population (and) they want to do an exam, they would be paid $14.89," she says. "The customary rate for that service is significantly higher. We've heard from private-practice dentists that it's a challenge to be able to provide care at those rates."

That's where organizations like Grand Rapids-based nonprofit Cherry Health can provide some relief for those in need of oral health care. As Michigan's largest Federally Qualified Health Center (FQHC), Cherry Health provides a variety of health care services, including oral health care, on a sliding fee payment scale. Cherry Health's current footprint includes 25 centers, spanning seven counties. Its School Linked program also provides dental and vision services in over 70 schools.

"We are obligated to provide services to those less fortunate (who) are located in the areas of (highest) need," says Cherry Health CEO Tasha Blackmon.

Looking to the future

While oral health care access has improved in many ways in Michigan, those engaged in the issue say there's still plenty of room for further advancement. Two key focus areas for the future are increasing access to care for youth and seniors, and promoting public awareness of oral health care access.

On the access side, one key issue is expanding Medicare to include dental care benefits. Oral Health America is currently piloting a Demand Medicare Dental campaign both in Grand Rapids and Lansing. States are not federally required to offer Medicare dental coverage, and Ketola says the program has come and gone in Michigan through MOHC's 15 years of advocacy.

"When budgets are tough ... the legislature (is) looking at places they (can) cut to balance the state budget," Ketola says. "Of course, (for) all of the optional services, such as dental and vision, ... the legislature has to make those choices on how to spend the state's money."

Shannon Kaza is the oral health coordinator at Health Net of West Michigan, a Grand Rapids nonprofit that established the Kent County Oral Health Coalition in 2011. She's currently involved in advocating for an increase in the payment reimbursement rate for dentists serving adult clients, which hasn't increased in Michigan since 1986. Kaza hopes that the state could eventually replicate the HKD model, which reimburses providers at an amount close to the going commercial rate, for adults.

Such a change would benefit more than just dental providers. It would also provide patients more options for oral health services and decrease their wait times for access. If it replicated the HKD model, patients would also receive a regular Delta Dental insurance card.

"The insurance cards look the same," Kaza says. "It removes the stigma (or) feeling of shame."

Looking beyond specific policy and service changes, Kaza says continuing to build general public awareness of oral health care access issues is crucial.

"People don't think about all the challenges there may be to getting dental care," Kaza says. "We want to inform as many people as we can in the community about what health equity is, what social justice is."

Kaza also wants to ensure that the people who are experiencing oral health care disparities are more engaged in that work.

"We really want them to inform our work rather than guessing at why these disparities exist or what would help," she says. "We want to have that two-way street of information so that we can be informed of what communities see as well as informing communities (about resources)."

Ketola says she'd like to see more medical organizations get involved in MOHC, such as hospital and physician associations. But she says individuals can play a significant role in shifting the paradigm as well.
 

"You don't need to be a lobbyist in Lansing or be a part of a large organization," Ketola says. "You really can just be passionate about improving oral health in your community, ... your family, or for yourself. I would encourage people to really become engaged in the work of their local coalition."