Community and Home-Based Oral Healthcare Pilot Application

The traditional model for healthcare has shifted over recent years as more adults look to receive care in non-traditional settings, such as their own home, rather than the standard hospital room or nursing home. The spread of home and community-based services (HCBS) is integral to providing services to those in most need, such as the homebound, or those experiencing barriers to traditional care centers such as lack of transportation and long wait times. Integration of oral health into the shifting and expanding health system is essential to the overall health of our population. 

Oral health has a significant impact on quality of life and systemic health. Populations with lower income and education are at greater risk for dental disease, including tooth decay and periodontal (gum) disease, and the data bears out these disparities. The data also reveals that many experiencing this heightened risk are Medicaid recipients. Dentists have cited historically low reimbursement rates, combined with increased operational costs, as the reason for low provider enrollment numbers. This lack of engagement creates a negative fallout for Medicaid recipients, who experience difficulty finding an accessible and available provider, and providers they successfully connect with have extended appointment wait times. Limited provider capacity results in only 15% of adult Medicaid recipients receiving preventive oral care services each year in Rhode Island. Unfortunately, that statistic manifests itself as nearly 5,000 people presenting to emergency departments annually with largely preventable cases of oral pain or infection. 

The COVID-19 pandemic exacerbated these challenges faced by providers and recipients. Many dental offices had to shut down for months and faced higher costs for supplies and staff upon returning, in addition to spending between $40,000 – 60,000 to make their practices “COVID safe.” Many older providers decided to retire, shrink their staff, sell their practices, or close completely, further limiting access to preventive dental care, especially for those with Medicaid. The current system is experiencing significant hurdles; therefore, it is time to look towards innovative care models to address the growing gaps in care.

The first component in achieving the new model is establishing a standard of oral care within Home Health Agencies, especially as more older adults turn to these non-traditional services. Training skilled and un-skilled home health providers on the importance of oral health, its connection to overall health, how to perform daily oral care tasks, and key signs of infection to check for, will begin to bridge the gap between our medical and dental systems.

The second component involves mirroring shifts in the medical field and work to provide care outside of the clinic and within public health settings. This is achievable through utilizing the unique training of public health dental hygienists (PHDH) and recent advances in tele-dentistry. PHDHs are qualified to provide preventive dental services in a public health setting, which includes residences of the homebound, schools, Head Start programs, nursing homes and long-term care facilities, licensed clinics, community health centers, hospitals, medical facilities, prisons, residential treatment facilities, federal, state or local public health programs, mobile dental facilities and portable dental programs. PHDHs are key to expanding the dental workforce because they are equipped to meet patients where they are. Dental clinics can expand their patient population through PHDHs servicing more patients without increasing the amount of patient time within the clinic. Also, tele-dentistry equipment allows dentists to “be in the room” with patients without leaving the clinic, letting the PHDH and dentist team to efficiently prioritize which patient needs immediate services within the clinic

The final key component involves more Medicaid recipients establishing a dental home and receive consistent preventive services. Most oral pain and infections can be avoided through regular checkups; however, people can go years without seeing a dentist, develop numerous issues and eventually require many complex services. Improving access to consistent oral care will limit the discomfort and pain felt by clients and decrease the number of complex visits experienced by providers. The State of Rhode Island heard the concerns raised by current and previous Medicaid providers and increased the adult dental reimbursement rates for the first time since 1992. EOHHS developed an informative Oral Health Transformation Toolkit to supplement the new rates and provide resources on how to be a successful Medicaid provider. Higher rates will encourage more dentists to enroll as Medicaid providers, increase the number of Medicaid clients with a dental home, and decrease use of emergency departments for oral pain and infections. Focusing on access to preventive services is key to improving oral health outcomes statewide. 

In summary, this innovative model seeks to make a landmark investment in the transformation of oral healthcare in Rhode Island, increasing service delivery within one year and improving equity for our most vulnerable and marginalized Rhode Islanders

Requirements:

• Each project proposal may include one or more funding tracks (1, 2 or 3). The stream of work specific to each track of funding should be clearly explained in the narrative and identified in the budget proposal. Should the applicant grantee apply for multiple tracks, they can reference how the grants would impact each other in their description.
• Grantees will be required to report the number of Medicaid clients by population group reached monthly by the funding of your approved application.
• A final report, project deliverables (if applicable), and accounting of all expenditures must be submitted to EOHHS no later than October 15, 2024. The anticipated start date for project implementation is between October 1-October 15. Monthly invoicing will be required for payment, grantees agree to provide documentation of expenditures. Grantees agree that documentation of expenditures will be available upon request.
• Grantees will commit to having a representative present at monthly virtual support meetings in which participants may both provide feedback to EOHHS about services provided and identified gaps, and learn from one another, adjusting service delivery as appropriate. Additionally, these meetings will serve as an information sharing point across the different grant areas, to ensure learning is integrated across the work and scope.    
• All applicants must register with the Ocean State Procures system in order to receive a standard purchase order and any approved funds. https://ridop.ri.gov/ocean-state-procures-osp/osp-vendor-registration

Scoring Criteria:

Each application will be scored based on how effectively they demonstrate the Community and Home-Based Oral Healthcare pilot connects with their overall approach to connecting medical care and dental care, and how this initial seed of funding will be used to help create a sustainable basis for the ongoing implementation of this pilot. The applicant must be in good standing as a certified home healthcare provider (Track 1) or a dental provider with an active Rhode Island license (Track 2 and 3). Non-certified or non-licensed providers are not eligible to apply. Applicants may apply for more than one track. No applicant will be awarded more than $50,000 in funding per track, and ultimately the award value will vary depending on how many eligible applicants apply and are selected during the pre-program analysis period (August, September, October 2023). Awards will be issued based upon the service capacity of the applicant, the total number of applicants, and the applicant’s request for funds as indicated in their applications.

To Apply:

Determine which sub-categories of support are the best match for your organization’s existing capacities and areas of opportunity. Applicants may request funds within multiple subcategories. If you have any questions regarding the application or requested information please reach out to:

• Sadie DeCourcy (Sadie.Decourcy@health.ri.gov)

Applications will be accepted on a rolling basis between now and September 15, 2023, at 4:00pm.