Issue 03
Summer 2019
Tribal Oral Health Newsletter
The Latest News on Oral Health from across Indian Country

In Your Inbox Every Quarter!
In This Issue
Tribal Dental Therapy News
NIHB Hosts Community Roundtables at Fort Peck Reservation
Class of 2019 Dental Therapy Graduates Plan to Serve Their Tribes
Dental Therapist’s Ties to Community Lead Her to Take on Other Roles

Updates from Capitol Hill and the Administration
Additional Legislation Introduced to Add Dental to Medicare 
Tribes Submit Comments on Community Health Aide Program Expansion Policy

The Latest in State Legislatures
Montana Tribes Tackle IHCIA Requirement in a Unique Way
Nevada Tribes Push Through Dental Therapy Law in First Step to Restoring Oral Health
Connecticut Approves Compromise Dental Therapy Law

Funding Opportunities and Resources
State by State Factsheets on Medicare Oral Health Coverage
Medicaid Resources
Oral Health Care Tips for Caregivers
IHS Dental Portal
Calling all Tribal Dentists:

If you support having a dental therapist as part of your team, join

Dentists and dental therapists work together as a team, each making the other's work stronger. It is very important that dentists working in Indian Country who support dental therapy make their voices heard!

Click here for more information on how to join the Partnership!
Tribal Dental Therapy News
NIHB Hosts Community Roundtables at Fort Peck Reservation
The National Indian Health Board (NIHB) hosted community roundtables in Poplar, Montana on the Fort Peck Indian Reservation. The roundtables provided NIHB the opportunity to hear from the community’s youth and elders on their oral health needs. Too often, the oral health care system leaves out both the youth and elders, and these groups go without care.

NIHB heard from participants on the barriers they face in receiving adequate oral health care, including needing transportation to the clinic, a shortage of providers, long wait times, and other challenges. Many of these barriers are common across Indian Country, and alleviating the oral health crisis among American Indians and Alaska Natives has been a longstanding priority for NIHB. Once the Community Health Aide Program expands to Tribes nationwide, Fort Peck plans to hire a dental provider under the new Montana state law (see “Montana Tribes Tackle IHCIA Requirement in a Unique Way”).

NIHB would like to thank the Fort Peck Tribe and Tribal Councilwoman Kaci Wallette for their hospitality and generosity, as well as the youth and elders who participated in the roundtables for sharing their stories.
Class of 2019 Dental Therapy Graduates Plan to Serve Their Tribes
On June 14, the 2019 class of dental therapist students graduated from the two-year Alaska Dental Therapy Education Program (ADTEP) surrounded by friends and family.

These ten new Dental Health Aide Therapists represent the largest class of graduating DHATs in the program’s history. ADTEP’s program has prepared them well for service in their communities, and seven of these graduates are going to return to their Tribes outside of Alaska! As the Community Health Aide Program expands to Tribes nationwide (see “Tribes Submit Comments on Community Health Aide Program Expansion Policy”), ADTEP will continue to serve as an invaluable resource for all of Indian Country.

This year also marks the 15 th anniversary of DHATs beginning to serve Alaska Native communities, and this strong graduating class is a testament to the program’s success and resolute focus on restoring oral health in Tribal communities.

The National Indian Health Board offers our sincerest congratulations and best wishes to the new Dental Health Aide Therapists!

To read more about the graduates serving Tribes outside of Alaska, click here!

Click here to learn more about ADTEP and ways your Tribe can support the program!
Dental Therapist’s Ties to Community Lead Her to Take on Other Roles
Shannon Hardy loves seeing a child’s smile after she has cleaned their teeth, or after she’s finished a procedure that takes their pain away. That’s why she works as a dental therapist with the Council of Athabascan Tribal Governments, serving her hometown of Fort Yukon, Alaska and surrounding villages. She has also embraced other roles in her community, including a term on the school board and a position as a Tribal judge!

Growing up, she was able to overcome her fear of the dentist because her dad always encouraged her. As she became more comfortable with seeing the dentist, she began to wonder how she might help others overcome their fear too. Shannon saw the need for more oral health staff from her time as a dental assistant, and with the guidance of elders in her community, as well as mentorship from her supervising dentist, Shannon embarked on a two-year path to become a certified Dental Health Aide Therapist. She relied on her family and community support network to watch after her five children as she completed the DHAT curriculum, first in Anchorage, then in Bethel.

When Shannon returned to her hometown and began seeing her friends and neighbors as a provider, she remembered how she felt as a little girl in the dentist’s chair. So she ran for and won a seat on the school board, and worked with school administrators to be able to treat the students in a setting familiar to them and to provide a sense of comfort and security that can often be missing in oral health care.

Shannon’s time on the Tribal court has also allowed her to serve as a mentor to Fort Yukon’s youth, especially when she works with families on Indian Child Welfare Act issues. She acknowledges that her roles in the community can be stressful at times, but she justifies it by saying "I love serving my community and helping my people remain whole."

Use NIHB's state legislative tracker to learn more about dental therapy legislation in your state and how you can help make access to oral health care a reality for the Tribes!
Join NIHB's
Second Thursday of Every Month

1:00 PM Eastern


Updates from Capitol Hill and the Administration
Additional Legislation Introduced to Add Dental Coverage to Medicare
In 2019, the National Indian Health Board passed a resolution calling for public health insurance programs to include dental benefits. While programs like the Children’s Health Insurance Program and Medicaid offer limited coverage for their beneficiaries, Medicare does not offer non-medical dental coverage for those enrolled in the program. This means that Medicare enrollees needing teeth cleanings, fillings, and other routine oral health care must either pay out of pocket or get supplemental insurance.

Medicare is a vital program for nearly 650,000 American Indians and Alaska Natives and serves an indispensable role in fulfilling the federal government’s trust responsibility for health. As Congress continues to deepen its understanding of the link between oral health and overall health, support for adding dental coverage to Medicare has grown.

Currently, Congress is considering the following legislation to add dental benefits to Medicare:

  • The “Medicare Dental Benefit Act of 2019,” S.22 from Senator Ben Cardin (D-MD) and its companion bill H.R. 2951 from Rep. Nanette Barragan (D-CA), which adds dental benefits to Medicare.
  • The “Medicare Dental, Vision, and Hearing Benefit Act of 2019,” H.R. 1392 from Rep. Lloyd Doggett (D-TX), which adds dental, vision, and hearing benefits to Medicare.
  • The “Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2019,” S. 1423 from Sen. Bob Casey (D-PA), which adds dental, vision, and hearing benefits to Medicare and increases the federal share of funding for dental provisions under Medicaid.
  • The “Seniors Have Eyes, Ears, and Teeth Act,” H.R. 576 from Rep. Lucille Roybal-Allard (D-CA), which adds eyeglasses, hearing aids, and dental care to Medicare.

While these bills are not expected to be enacted into law this Congress, the fact that so many members of Congress and Senators are examining the issue bodes well for the prospects of offering dental coverage for Medicare beneficiaries in the future.
Tribes Submit Comments on Community Health Aide Program Expansion Policy
Tribal appointees to the Community Health Aide Program Tribal Advisory Group (CHAP TAG) have worked with the Indian Health Service for over a year to develop the agency’s policy for national expansion of CHAP. The program currently operates only in Alaska. The Indian Health Care Improvement Act authorized IHS to expand the program to Tribes outside of Alaska, and in 2016, IHS announced that it would do so.

The CHAP TAG has worked tirelessly with the IHS to create a policy document outlining the certification process for community health aides, behavioral health aides, and dental health providers working under the national CHAP and the responsibilities of Area Certification Boards and Academic Review Committees. The TAG was formed to ensure Tribes are adequately engaged in crafting a program that will provide crucially needed health services to Tribes in rural and remote locations. Tribal involvement has been crucial, as the TAG ensure that Areas and Tribes have the flexibility and authority they need to make the program a success.

On May 8, IHS announced that the policy was beginning Tribal consultation and that the agency would accept comments until June 7, 2019. For more information, visit the CHAP TAG website.
Oral Health Champion's Corner
This issue’s Oral Health Champion is Tiffany George, Dental Health Aide Therapist at the Tanana Chiefs Conference, where she has worked since graduating from the Alaska Dental Therapy Education Program in June 2017!

Since then, Tiffany has worked in her hometown of Galena and the surrounding villages. She loves seeing American Indians and Alaska Natives in higher education for health services and returning to their hometowns to serve their people. She is thankful to her Tribal organization and the Alaska Native Tribal Health Consortium for giving folks like her the chance to improve her people’s oral health and wellness.

Tiffany’s favorite part of her career is working with the 200 children from across Alaska living in Galena’s boarding school and being able to improve their smile and self-esteem about their teeth.

Thanks for all you do to keep Indian Country smiling, Tiffany!
The Latest from State Legislatures
Montana Tribes Tackle IHCIA Requirement in a Unique Way
The Indian Health Care Improvement Act (IHCIA) is a seminal law greatly improving the Indian Health Service’s ability to provide quality health care to American Indians and Alaska Natives. The law allowed IHS to expand the Community Health Aide Program (CHAP) from Alaska to Tribes throughout the country based off of that program’s success in providing medical care, behavioral health, and dental health services to remote Alaska Native communities. Unfortunately, IHCIA also included a political requirement that Tribes outside Alaska get permission from their states to use dental therapists under CHAP. This is why so many Tribes have asked their states to license dental therapists.

But Montana Tribes did it differently. They asked the legislature to consider a bill that allows CHAP providers—including dental therapists—to work for Montana Tribes without a state license. CHAP providers receive federal certification in lieu of a state license, and legislation recognizing the sufficiency of that certification sailed through the Montana State House of Representatives. The Senate was a bit trickier, with compromise legislation limiting the scope of CHAP’s dental providers passing by only 5 votes. A conference committee worked out the differences, and both the House and Senate passed the final bill. Governor Bullock signed it into law on May 9, making Montana the 11 th state with a mechanism for Tribes to employ CHAP dental providers.
Nevada Tribes Push Through Dental Therapy Law in First Step to Restoring Oral Health
Nevada’s Tribes have achieved unprecedented success in the state legislature: the Tribal campaign to authorize dental therapy successfully advocated to the Nevada Legislature and enacted a dental therapy law! The new law does require all dental therapists licensed by the state to have a hygiene requirement, but also explicitly includes Tribal facilities as applicable practice settings. The campaign to pass the law was largely driven by the state’s Tribes, and S.B. 366 overcame significant opposition.

But this new law is just the first step. The Tribes have already begun advocating to strengthen the law by incorporating evidence based standards for licensure and for reciprocity for Nevada to recognize dental therapy licenses from other states. In the meantime, the Tribes in Nevada are working with the University of Nevada Las Vegas as a potential site for the education program for dental therapists who will eventually work for the Tribes.

Nevada is now the 12th state to authorize dental therapy in Tribal communities!
Connecticut Approves Compromise Dental Therapy Law
Connecticut lawmakers have approved a new dental therapy bill that serves as a compromise between underserved communities and other interest groups.

The new law, which was signed by Governor Lamont on June 28, provides a pathway to license dental therapists in the state of Connecticut. However, the legislation included two provisions that may lessen the workforce model's effectiveness in the places it is needed most.

First, the legislature included a requirement that all dental therapists practicing in the state also obtain a dental hygienist license. This means that instead of following the evidence-based standards developed by the Commission on Dental Accreditation that call for three academic years of education for a dental therapist, applicants for a state license will now have to complete up to eight years of dental hygiene education.

Second, the legislature required that a dentist employing dental therapists supervise every procedure they conduct for their first 1,000 hours, or nearly six months of full time employment. Other states have found success in 400 or 500 hour requirements to ensure competence. 1,000 hours of supervision will accomplish nothing more than burden dentists.

However, this significant law does represent another victory for the spread of dental therapy. When Governor Lamont signed S.B. 807 into law, Connecticut became the 13th state to have some mechanism for dental therapists to practice.
Funding Opportunities & Resources
State by State Factsheets on Medicare Oral Health Coverage

Families USA has created factsheets detailing the health and economic impact that a dental benefit under Medicare would have in each state.

These factsheets show the positive public health outcomes that would result from Congressional action to entend Medicare's coverage to non-medical dental services.
Medicaid Resources
Medicaid dental benefits vary by state.

The Center for Health Care Strategies, Inc. has a fact sheet providing an overview of Medicaid adult dental coverage by state here.

You can also learn more about Medicaid dental health coverage by visiting the Medicaid website.
Oral Health Care Tips for Caregivers

The NIH National Institute of Dental and Craniofacial Research developed a series of fact sheets for caregivers who help someone brush, floss, or visit the dentist.

Suggestions range from ways to help elders find low-cost dental care to how to make holding a toothbrush easier.

Click here to view the fact sheets!
IHS Dental Portal
The IHS Dental Portal contains resources including reports and data on Tribal oral health.

The IHS gathered data as part of the 2010, 2014, 2015, and 2016-2017 Oral Health Surveys.

To view the draft IHS Division of Oral Health Strategic Plan for 2018-2017, click here.
910 Pennsylvania Avenue, SE
Washington, DC 20003
Main Phone: 202-507-4070
Fax: 202-507-4071