Have a Heart for Kids Day 2020

Innovation that Kids Need

Adam 01/13/14


Our elected representatives returned to Olympia this week, and in the midst of a fragile economic recovery, many of them are asking an important question: How do we manage the state’s finite resources in ways that build strong families and healthy communities?

There’s growing momentum for one good answer: a mid-level dental practitioner trained to provide routine, cost-effective oral health care where it’s most urgently needed.

Last week, more than 100 participants joined the Washington Dental Access Campaign for a web-based learning session on mid-level providers in other parts of the United States. Convened by the Children’s Alliance, the hour and 15-minute session inspired a host of great questions among participants. We thought we’d share three of them:

Why push for workforce changes in Washington now?

Our current dental system is failing kids, parents, seniors and disabled Washingtonians. There is a crisis in oral health, caused by lack of access to routine, preventive care. Without it, unmet dental needs are the number-one reason an uninsured Washingtonian falls back on the emergency room. Uncompensated treatment in our state’s ERs costs us all.

Right now, state policies and the federal Affordable Care Act are connecting an estimated 700,000 Washingtonians – one in nine – with Medicaid dental coverage. That’s something to celebrate. But coverage alone will not transform our broken dental health care system into one that serves us all.

Three out of four Washington dentists do not accept Medicaid. And dentists are also scarce in some of the communities who need dental care the most. Thirty-five of Washington’s 39 counties have federally recognized shortages in the oral health workforce.

Mid-level practitioners are already at work in other U.S. states, and in more than 50 countries, to improve access to oral health care. They are proven to provide safe, quality care. More than 15 other states are considering similar innovations. The kinds of changes that came when nurse practitioners and physician assistants entered the medical field – changes that lowered costs and expanded patient choice – are long overdue in the field of dentistry.

Do mid-level practitioners make financial sense?

Workforce innovations save money while expanding access. The payroll cost of dental practitioners in Minnesota, for example, is 40 percent less than the cost of a dentist. Mid-level practitioners’ training costs are lower as well.

Medicaid reimburses health care providers at a lower level than other insurers, creating another barrier to care. Public health advocates frequently cite these low reimbursement rates when talking about disparities in access to care. Yet raising reimbursements is expensive; lack of innovation is a more soluble problem. The National Bureau of Economic Research recently noted that mid-level providers may be a more cost-effective way to expand access to care than higher Medicaid reimbursements. Mid-level workforce solutions have also been proven to decrease the cost of care, especially for children.

There seem to be plenty of dentists in my area, where is the need?

Most every Washington county outside of the Seattle-Tacoma and Vancouver areas faces a shortage of oral health providers. This shortage affects people of all ages. Children in communities of color and children in low-income families are disproportionately likely to suffer from a lack of routine care. Families in rural areas face a long drive to get to a clinic – if it accepts their form of insurance. And even in urban areas, 3 out of 4 dental practices do not accept the primary form of non-employer dental coverage for children and adults, Apple Health.

Workforce innovation means we don’t reinvent the wheel – we bring new ways of providing care to Washington’s underserved communities. That’s why we need a community-based provider with the power to extend care to those who have been waiting too long without it.

To learn more about the workforce innovation championed by the Children’s Alliance and the Washington Dental Access Campaign, visit