Issue 04
Autumn 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 Welcomes National Coalition of Dentists for Health Equity to National Partnership for Dental Therapy
2019 National Tribal Health Conference Celebrates 15 Years of Tribal Dental Therapy
Licensing Reciprocity with Swinomish Offers Washington Tribes a Pathway to Hire Dental Therapists

Updates from Capitol Hill and the Administration
Medicare Dental Act of 2019 Advances in House 
Community Health Aide Program Expansion Update

The Latest in State Legislatures
Wisconsin Tribes Advocate for Oral Health as Dental Therapy Bill Advances
Michigan Draft Dental Therapy Rules Released for Public Comment

Funding Opportunities and Resources
Native American Pre-Dental Student Gateway Program
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 Welcomes National Coalition of Dentists for Health Equity to National Partnership for Dental Therapy
On October 1, 2019, the  National Indian Health Board  celebrated the launch of  The National Coalition of Dentists for Health Equity (DHE) . The coalition is now the third co-chair of the National Partnership for Dental Therapy. Together with DHE and  Community Catalyst , the National Indian Health Board stands as a leader in the effort to expand dental therapy nationwide.
For years, the National Indian Health Board's  Tribal Oral Health Initiative  has provided outreach, education, and technical assistance, serving as a resource for Tribes seeking to bring dental therapy to their own communities.
"NIHB is pleased to welcome DHE to the fight for dental therapy," said NIHB Chairwoman Victoria Kitcheyan, Winnebago Tribe of Nebraska.  "As Tribes continue to assert our sovereign right to employ dental therapists, the voice of dentists inside and outside of the Indian health system will play a vital role. We have seen time and again that dentists are some of the strongest advocates for Tribal dental therapy, and we at NIHB are eager to work with DHE and Community Catalyst as co-chairs of the National Partnership for Dental Therapy to ensure every community has access to oral health care."
DHE will serve as an invaluable partner in this effort as it seeks to elevate the voices of dentists from across the county to advance health equity through support of evidence-based practices like dental therapy.
To learn more about the National Partnership for Dental Therapy, visit .
2019 National Tribal Health Conference Celebrates 15 Years of Tribal Dental Therapy
On September 19, 2019, the National Indian Health Board (NIHB) concluded its annual National Tribal Health Conference by celebrating 15 years of dental therapy in Alaska Native communities.

Nationwide, one dentist serves about 1,500 people. But in Indian Country, there is only one dentist for every 2,800 people. Dental Therapists are mid-level oral health providers trained and licensed to perform preventative and routine oral health care procedures. These integral providers have been operating in Alaska Native communities under the Community Health Aide Program (CHAP) since 2004.
“The National Indian Health Board is pleased to celebrate the Dental Health Aide Therapy program at our national conference. These innovative oral health providers have been practicing in Alaska Native communities for 15 years and have changed the landscape of care in Alaska,” said NIHB Chair and Great Plains Area Representative Victoria Kitcheyan. “Oral health is often overlooked or there is an undesirable connotation attached to it. But in Alaska and many other Tribal communities, dental therapists are a proven success and have helped fill a gap in oral health access by providing routine preventative and restorative oral health services, and it has greatly changed lives, particularly for Alaska Native youth.”
NIHB hosted a panel discussion at its conference that focused on the journey and success of dental therapy in Alaska and nationwide, and the positive impact dental therapists have made in Indian Country. 
“After just 15 years of dental therapy in Alaska our communities are experiencing measurable improvements in oral health. Dental therapy is giving Alaska native people something to smile about and proving how Tribal sovereignty is the power to do better,” said Dr. Mary Williard, a dentist and Director for the Department of Oral Health Promotion at the Alaska Native Health Consortium.
The Alaska Native Tribal Health Consortium first developed dental therapist programs within the Yukon Kuskokwim Health Corporation. In many Alaska Native villages, access to dentists or any oral health program is limited. and tooth extraction was a common practice, even with children. 
Other panelists were Dane Lenaker, Senior Clinical Director with the Southeast Alaska Regional Health Consortium, and Caroline Brunton, Program Officer for the W.K. Kellogg Foundation. 
Licensing Reciprocity with Swinomish Offers Washington Tribes a Pathway to Hire Dental Therapists
While many Tribes have advocated for the incorporation of dental therapists into the Indian health system through either state licensure or federal certification, a Tribe in Washington has charted a course for a third way. In January 2016, Swinomish Tribe in Washington State hired a dental therapist licensed by the Tribe itself.

Swinomish had worked for several years to create a licensing board, which are typically entities run by state governments, using its inherent sovereign authority. As the Centers for Medicare and Medicaid Services (CMS) continue to stall on a decision regarding Medicaid reimbursement under Washington State’s dental therapy law, other Tribes in the state have begun looking for innovative solutions.

Swinomish’s licensing board offers just such a solution. If a Tribe so chooses, it could replicate Swinomish’s path itself, or, to avoid needing to spend time and resources on establishing such a board, the Tribe could enter into a reciprocity agreement with Swinomish. This would mean the Tribe would recognize a license issued by Swinomish as valid to practice within its health care system. While not every Tribe in Washington State would want to do this, the pathway for reciprocity makes employing dental therapists for those Tribes interested much more feasible.
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!
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Updates from Capitol Hill and the Administration
Medicare Dental Act of 2019 Advances in House
On October 22, 2019, H.R. 4650, the Medicare Dental Act of 2019, was advanced out of its second of two committees and now awaits a vote in the full House of Representatives. The legislation would expand Medicare Part B to include benefits for dental services, an expansion supported by the National Indian Health Board.

When Congress created Medicare in 1965, the program only covered hospital care (under Part A) and medical care (under Part B) for Americans over age 65. Congress has expanded Medicare’s impact several times in the decades since, including offering coverage to Americans living with disabilities, covering kidney dialysis for Americans with End Stage Renal Disease, and offering a prescription drug benefit under Part D. Currently, Medicare does not offer any benefit for oral health care services except for inpatient services offered in a hospital, meaning that Medicare beneficiaries must secure supplemental insurance to obtain dental checkups, dentures, cavity fillings, and other dental services—or go without care.

Medicare currently covers approximately 450,000 American Indians/Alaska Natives (AI/ANs) over the age of 65 and another 200,000 AI/ANs living with disabilities. For more information on how Medicare interacts with the Indian health system, click here.

While legislation adding a dental benefit to Medicare beneficiaries faces steep odds in the current Congress, its advancement through committee means that the House of Representatives may take a vote on it in the near future.
Community Health Aide Program Expansion Update
As the Indian Health Service (IHS) continues the work behind expanding the Community Health Aide Program (CHAP) to Tribes outside Alaska, the CHAP Tribal Advisory Group (TAG) is working to ensure the interim policy reflects Tribal priorities.

At the most recent CHAP TAG meeting on September 9, 2019, IHS presented the 263 comments submitted by Tribes during the consultation period for the draft interim policy and asked for the CHAP TAG’s input. To ensure adequate attention was given to each comment, the TAG requested additional time. This topic is expected to be discussed further at the next CHAP TAG meeting, which has yet to be scheduled.

To read the comments submitted by the National Indian Health Board, click here.

Before the interim policy for CHAP expansion can go into effect, it must be submitted for review by both the IHS and by the Department of Health and Human Services. Because of these review processes, the interim CHAP policy is not expected to take effect until 2020.
Oral Health Champion's Corner
This issue’s Oral Health Champion is Dane Lenaker, DMD, MPH, the Senior Clinical Director for the Southeast Alaska Regional Health Consortium!

Dr. Dane Lenaker has spent the last ten years working in extremely remote and heavily underserved areas to enhance dental access to Alaska Native patients. He has contributed to the growth and development of dental therapy programs in Alaska, Oregon, and Washington through mentorship, hands on instruction, data analysis and interpretation.

Dr. Lenaker was an author in a key research article demonstrating the value in dental therapists within Alaska Native communities. He actively participates with the Alaska Medicaid Advisory Committee, a board which supports Medicaid in the state of Alaska and ultimately access to care for many Alaska Natives.

Thanks for all you do to keep Indian Country smiling, Dane!
The Latest from State Legislatures
Wisconsin Tribes Advocate for Oral Health as Dental Therapy Bill Advances
On August 21, 2019, the Wisconsin Senate Committee on Health and Human Services held a hearing on Senate Bill 81, which would establish dental therapy licensure in the state. Oneida Nation of Wisconsin Vice Chairman Brandon Stevens offered testimony before the committee regarding his Tribe’s support for dental therapy and the barriers to oral health access that his community experiences.

The hearing was the first time the Wisconsin legislature heard testimony from across the state on dental therapy. Because the bill would implement dental therapy statewide, Tribes and non-Tribal communities spoke in favor, while the state chapter of the Dental Association spoke in opposition. In addition to Oneida Nation, representatives from Menominee College spoke in favor of the bill and expressed their desire to implement a dental therapy education program at the Tribal College.

The legislature does not have many legislative days remaining in the 2019 session, so advocates in the state are urging State Assembly and Senate leaders to advance the dental therapy legislation before time runs out.

Click here for more information about Wisconsin's legislation.
Michigan Draft Dental Therapy Rules Released for Public Comment

The Michigan Department of Licensing and Regulatory Affairs has released draft rules related to the state's dental therapy law, passed by the state legislature in 2018. The draft rules cover the state's entire dental code, and rules related to dental therapy are a subset of the document.

Overall, the rules cover topics such as licensure for new dental therapists, dental therapists licensed in another state who move to Michigan, clinical practice standards, state approval of dental therapy education programs, and other issues.

The state has not yet announced a deadline for public comment on the rules but is expected to do so soon.

Click here to read the draft rules.

For those Tribes in Michigan interested in providing comments on the rules, please contact Brett Weber, NIHB Congressional Relations Manager, at [email protected].
Funding Opportunities & Resources
Native American Pre-Dental Student Gateway Program

The Seneca Nation Health System and the University at Buffalo School of Dental Medicine have developed a ‘Gateway to Dentistry’ internship program for Native American undergraduate students considering application to Dental School. 

Click here for more information!

June 22-26, 2020
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.
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