Good oral health is crucial to overall health and well-being. Yet the nationwide shortage of dental health professionals poses a significant barrier to access to oral health. The federal government has designated more than 6,860 communities across the United States as having a shortage of dental health professionals. To address these gaps in oral health access, states should partner directly with health centers to ensure patients have access to the comprehensive and innovative services that health centers provide.
To assist with the expansion of the dental workforce, NACHC, in partnership with participating Primary Care Associations (PCAs) and community health centers, and with funding from the CareQuest Institute for Oral Health, recently released a guide on state policies and strategies to strengthen the dental workforce in health centers.
Health centers are one of the largest employers of dental health professionals
Health centers provide essential dental services to over 6.4 million patients including 1 in 8 children and 1 out of every 10 people living in the US. Health centers are one of the largest employers of dental health professionals, employing over 20,000 across nearly 1,500 service sites nationally.
State legislation can invest in and incentivize programs to support the dental workforce
Several State PCAs and health centers are seeking to address the shortage of healthcare workers, especially dental professionals, during their upcoming state legislative session. State legislatures are naturally prime leaders when it comes to advancing solutions to the dental workforce shortage. State legislatures have the authority to create state-based policies that establish resources for dental workforce programs such as state tax credits to support workforce housing or incentives for commercial insurers to partner with health centers. They also can show where their priorities are through their appropriation authority, meaning they can appropriate funds that invest in workforce development programs through grants for purchasing mobile clinics, professional training, student scholarships, loan repayment assistance programs, and more.
Health centers have a role to play in advocating for policies to support the dental workforce
Health centers and PCAs, on the other hand, are naturally some of the best partners to guide the implementation of these policies. Health center advocates should use real life examples to support your state’s implementation and ensure programs will actually benefit the patients and providers in the community.
This guide serves to help advocates identify existing models of state policies and effective strategies they can use when engaging with state lawmakers. The report breaks down the strategies into three buckets: Training, securing funds, and maximizing licensure.
Examples of strategies to expand the health center workforce
TRAIN: These involve state policies and strategies to expand health center-based training to strengthen workforce pathways and connect students to community health careers. Studies indicate that state investments in dental schools have lagged while there has been an increasing demand for services. Health centers are in a great position to partner with their State as a training site and a pipeline program for current and aspiring students. Health centers are usually located in communities with the greatest need, allowing students to gain practical experience while providing much-needed care to those in need.
“Shining Star” example: The Ohio Association of Community Health Centers (OACHC), the state’s PCA, negotiated funding with the Ohio Department of Health (ODH) for the Ohio Primary Care Workforce Initiative. This initiative provides funding to health centers to oversee the training and education of dental and other students of health professionals during their clinical rotations. Funding for the initiative has been appropriated biennially in ODH’s budget since 2015. This biennial appropriation is approximately $5.4 million and is administered by OACHC under a contract from ODH every two years to support clinical rotations.
SECURE: These are state policies and programs that establish workforce incentives that help health centers recruit and retain mission-oriented professionals. This includes state appropriations for scholarships, loan repayment, and policies promoting innovative program investments. To address the dental workforce shortage, States can partner with health centers and PCAs to develop incentives and resources to ensure dental providers enter the workforce and can continue serving health center patients.
For example, a scholarship program incentivizes individuals to seek employment at a health center and stay for longer periods of time because they receive money to obtain their degree and licensure in exchange for a work commitment. This type of program would reduce financial barriers, ensuring that the worry of student debt isn’t a main factor in their decision making.
“Shining Star” example: In 2022, Project Access was established to provide Nebraska FQHCs with flexible funding to expand and enhance access to quality, community-responsive care unique to their communities. As the state PCA, HCAN oversees these relationships, governs the Project Access Steering Committee, and completes required reporting for all funders and partners. This initiative was initially funded by Nebraska Total Care (a subsidiary of Centene) and the Centene Foundation.
Project Access was developed as an innovative means to increase access to care throughout the state. Since this time, additional Nebraska Medicaid Managed Care Organizations have come to the table and pledged a portion of their profits to aid the Nebraska health centers, their workforce, and their local communities.
MAXIMIZE: These include state policies and programs that encourage dental workforce innovations and authorize dental professionals to practice to the top of their license to extend capacity within health centers. Having every dental provider being able to work at the top of their training is an important way to grow the dental workforce and expand access to care. This means that providers will be able to provide the entire range of services and procedures they are trained in. Some state laws limit the scope of work a certain professional is allowed to provide.
This requires places like health centers to employ staff for specific services rather than allowing someone who is trained to deliver the care. In DHPSAs, there is the risk that there are not enough providers which could lead to the health center being unable to provide certain services. States can remove regulatory and/or policy barriers to licensure and scope of practice for dental health professionals to ensure each member of the dental care team is working at the top of their training.
“Shining Star” example: In 2011, the Oregon Legislature passed legislation that allowed the establishment of a dental pilot program strategy under the Oregon Health Authority to encourage innovation in oral healthcare delivery systems. Virginia Garcia Memorial Health Center participated in the established and approved pilot project #300 where experienced dental hygienists with a restorative endorsement were trained to become dental therapists, providing extended access to dental services in clinics and other community-based settings such as school-based clinics and mobile vans. This pilot is approved through January 2025, although many of the participants are now licensed dental therapists and no longer operate within the authority of the pilot. The success of the dental therapy pilot projects led to the Oregon Legislature to pass House Bill 2528 in 2021 which established the licensed role of dental therapists in the state.
Health centers working with policymakers can strengthen and expand the dental workforce
States have a critical responsibility to bridge the oral healthcare gap, especially for historically marginalized communities, and should partner with providers rooted in these communities to ensure patients’ needs are met. Health centers have long championed health equity with roots in the Civil Rights movement and are among the nation’s leading providers of dental care to under-resourced communities. There is a nonpartisan agreement that we must tackle the growing dental workforce shortage. This is the moment for health center advocates to work with their state legislatures to pass policies that help them reach a position where they are the provider of choice in their community. NACHC urges states to adopt the policies and best practices outlined in this report and inspire health centers in their state to become shining stars for oral healthcare as well.
Read the guide and access additional resources.