Below is testimony The Arc Wisconin provided on a proposal to approve dental therapy in the state, a process that has resulted in improved access to dental care for people with disabilities in other states.

Download an electronic copy of the testimony here.

December 18, 2019

To:      Representative Rob Summerfield, Chair

Members, Assembly Medicaid Reform & Oversight Committee

From: Lisa Pugh, Executive Director – The Arc Wisconsin

Re: Support for AB 81 – Dental Therapy

Thank you for the opportunity to share testimony today on AB 81.

The Arc Wisconsin is a statewide organization that advocates for people with intellectual and developmental disabilities (I/DD). We have 14 Wisconsin chapters and are connected to a network of more than 600 chapters across the country. The Arc is the oldest and largest disability rights advocacy organization in the nation.

Our Arc chapters are reporting a dental crisis for people with I/DD living in their communities. The Arc Richland County indicates a more than three year wait for root canal procedures for Medicaid recipients. They say, “We just can’t get the services for a very painful and dangerous condition, so we pull teeth creating more care needs for the future.”

The Arc Fond du Lac reports dental access as a struggle for the people they support, going back at least five years; Many people who had an established dentist, suddenly had to look for a new practitioner because their dentist terminated Medicaid coverage. This resulted in many participants from The Arc Fond du Lac going without dental care for several months, sometimes as long as a year; Others had to find transportation to Milwaukee providers as these were the only dentists taking their insurance. Those who could not find scarce transportation supports went without dental care or worse. In the worst examples, several people had to go to the emergency room to receive prescriptions for abscesses – others had to have their teeth pulled; In some cases, teeth were pulled – even if someone did not want them to be – because cost prevented them from getting a repair.

These stories represent the tip of the iceberg in terms of statewide access to dental care for many people with disabilities, including children.

The DHS Medicaid Plan for Monitoring Access to Fee-for-Service Health Care gives us a sense for dental care access in Medicaid, which most people with I/DD rely upon for their dental care. Their data shows that only 37% of licensed dentists are available to serve the Medicaid population, lower than rates for other provider types. 53% of these dentists enrolled as providers in Medicaid were either inactive (not accepting new patients) or reported limited participation in the program. Utilization of dental services in Medicaid varies widely by region, particularly for children.

This bill would allow dental therapists to practice in Wisconsin like they do in other states, expanding access for underserved populations.  A licensed dental therapist works under the supervision of a dentist and can provide important preventative and restorative dental care. The Arc Wisconsin and other disability organizations believe that authorizing dental therapists will increase access to dental care for underserved areas and populations in Wisconsin.

The data shows us that people with disabilities in Wisconsin who have great challenges obtaining regular dental care, often end up enduring preventable extractions, high rates of periodontal disease, and other poor health outcomes related to inadequate dental care.

  • State data indicates that 29% of adults with disabilities reported having at least one permanent tooth removed over the past year, and 26% said they had not visited a dentist within the past year.
  • 2 million people live in areas –mostly rural–with dentist shortages. The federal government reports shortages in 64 of our 72 counties.
  • Adults with a disability are less likely to visit the dentist for a cleaning, check-up, or exam than people without disabilities (47% and 76%, respectively).
  • People with disabilities are more likely to visit the dentist when something was wrong or causing pain (29% and 12%, respectively), as compared to adults without a disability.

According to the Minnesota Office of Rural Health and Primary Care in their September 2019 report on Minnesota’s Dental Therapist Workforce, 81 percent of dental therapists serve patients with disabilities daily. Advocates for people with disabilities in Minnesota support the role of dental therapists. Early results after implementation of that dental therapy program showed that overall, nearly one-third of all patients surveyed experienced a reduction in wait times for an appointment since the dental therapist was employed, with the impact more pronounced in rural areas. Some patients saw a reduction in travel time for their appointment with the dental therapist compared to their last appointment, again most notably in rural areas.

Wisconsin must do something to improve dental access for underserved populations, including people with disabilities. While dental therapy will undoubtedly improve the situation, there is more work to be done. We request your continued attention to other issues including, lack of accessibility in dental offices, the extremely limited specialized facilities available for sedation dentistry, and overall low Medicaid reimbursement rates for dental care.

Thank you again for the opportunity to testify.