Bills aim to improve access to dental care in North Dakota

Two bills being considered by the North Dakota Legislature strive to make dental care more accessible to low-income and under-represented populations across the state. Supporters say the bills are needed but merely begin to address unmet dental care needs in the state.

House Bill 1567 would fund a study of the dental health care status among Medicaid recipients and look at ways to recruit dental care providers to improve access for low-income children, Native American children and people with disabilities. 

Senate Bill 2231 would add dental coverage to Medicaid Expansion, the health insurance program for adults who aren’t eligible for Medicaid but whose household incomes fall below 138% of the federal poverty line.

“We need to take action,” said Rep. Mary Schneider, D-Fargo, who is one of the sponsors for the House bill. “We need effective and permanent ways to address lack of dental access for groups who rely on Medicaid for oral health.”

Adding dental benefits to the Medicaid Expansion program is one step toward that goal, supporters of Senate Bill 2231 say. Currently, anyone on Medicaid receives dental benefits, but those who receive insurance through the Medicaid Expansion program don’t. 

Tammy King is executive director of Bridging the Gap, a nonprofit dental clinic that operates in Bismarck. She said that patients often set up an appointment thinking they have dental benefits through Medicaid and only later find out they’re on the Medicaid Expansion program. 

“We can at least offer patients a discounted rate, but it’s confusing and frustrating for patients,” she said. “Our staff spend a lot of time explaining this to people.”

Nadine Boe, CEO of Northland Health Center in Turtle Lake, says the addition of dental benefits to Medicaid Expansion also will encourage patients to seek preventive and restorative care, which will result in improved health and reduced costly emergency visits.

In addition, increased Medicaid reimbursements for dental services would enhance her center’s financial sustainability and allow the center to recruit more dentists and potentially expand to more locations. 

Northland Health Center is one of five federally qualified health centers across the state. These centers provide primary medical care, behavioral health services and dental care to anyone regardless of ability to pay. 

“By adding benefits to Medicaid Expansion, this will bring more resources into the dental care system and strengthen it for everyone,” said Shelly Ten Napel, CEO of the Community HealthCare Association of the Dakotas. “It won’t solve all our problems. But it will help us expand.”

Approximately 23,300 North Dakotans rely on Medicaid Expansion for their health care coverage as of January. Adding dental benefits would cost the state about $500,000, according to testimony shared with the Senate Health and Human Services Committee. It’s also estimated to cost about $4.6 million in federal funds.

But these costs may offset what is being spent in emergency care. More than 1,700 people visited a North Dakota emergency room for tooth pain in 2021, according to data from the state Department of Health and Human Services.

“In the end, we will save a lot in health care costs,” said Sen. Judy Lee, R-West Fargo, one of the sponsors for the Senate bill. “Also, people will seek care earlier, so they won’t miss as much school and work.”

Lack of insurance coverage is only one of the barriers keeping people from receiving dental care in the state.

In North Dakota, about 44% of the need for dental providers is being met, according to a report from the state Department of Health and Human Services. Rural and low-income areas in the state face the most shortages.

The same report shows health of the mouth is directly related to overall health. Oral diseases like tooth decay (cavities) and periodontal (gum) disease are associated with many serious health problems like Type II diabetes, heart disease, lung disease, stroke, dementia, low birth weight, and pre-term birth.

The legislative study proposed by House Bill 1567 would dive deeper into the barriers that keep people from seeking dental care and the reasons private dental clinics may decline or limit the number of Medicaid patients they serve.

Bridging the Gap serves patients who receive ND Medicaid benefits, in addition to those who are uninsured, under-insured and low-income. The clinic receives calls daily from people who say it’s the only clinic accepting new Medicaid patients, King said.

“Everybody is at capacity, so they don’t need to reach out to those on Medicaid,” she said.

The Legislature has commissioned studies before, but no action plans were drafted, said Rep. Schneider. The state needs to better understand how to recruit dentists and other dental care providers, she said. It needs to understand why people don’t seek dental care before it’s an emergency.

“We’ve documented unmet needs, but we haven’t addressed the barriers in the system,” she said. “That’s where we need to make progress.”

This story was updated to correct the number of North Dakotans on Medicaid Expansion and the cost estimate of the bill.