The Fort Peck Assiniboine & Sioux Tribes in Montana have declared a state of emergency for the reservation due to a lack of oral health care access.

The Tribe conducted a community health assessment in 2016 found that 1 in 3 high school students had not received dental care in over a year, and that the Tribe's population to dentist ratio was 43% higher than the national average, indicating a shortage of dentists.

The Tribe is hopeful that the declaration will lead to an increase in funding for much needed dental staff across the reservation.

The National Indian Health Board hosted a series of roundtables at the Tribe in 2019. Many participants noted that wait times for dental appointments can be over six months and that many patients are referred to Billings for complex dental care, which requires a nine-hour roundtrip drive. Click here to read more about the roundtables.

The National Indian Health Board is proud to announce the 2021-2022 recipients of the Tribal Oral Health Initiative’s dental therapy in Indian Country funding opportunity. These Tribes and Tribal organizations will work on projects related to dental therapy, including implementing the innovative workforce model in Tribal dental clinics, recruiting community members to look at a dental therapy career, and educating Tribes and other stakeholders on the benefits dental therapy can bring to underserved communities. This year’s recipients are:

·       Swinomish Indian Tribal Community

·       Northwest Portland Area Indian Health Board

·       Southern Plains Tribal Health Board

·       Intertribal Council of Arizona

A partnership between indigenous communities and universities in Saskatchewan aims to begin training dental therapists in the Canadian province by March 2022. Like American Indians/Alaska Natives in the United States, indigenous peoples in Saskatchewan suffer from poor oral health outcomes stemming in large part from historical trauma, alienation from traditional foods, and a shortage of dental providers. First Nations leaders in the province are working to ensure dental therapists are the reliable, culturally competent, and effective solution to oral health needs in their communities. In the 1970s and 80s, dental therapists trained and worked in the province, but funding cuts eliminated the education program, and there has been no dental therapy education program in Canada since 2011. More information on dental therapy in Canada can be found here.

This new pilot project in Saskatchewan is the latest example of indigenous communities benefitting from dental therapy’s flexible, accessible workforce model. While National Indian Health Board serves only federally recognized Tribes in the United States, this development is another example of indigenous communities working to improve their own oral health care and will serve as a positive example to Tribes in the U.S. looking to do the same.

In 2010, Congress created the Alternative Dental Health Care Provider Demonstration Project to allow states and Tribes to bring innovative oral health care workforce models to their communities. This $60 million program would have allowed Tribes selected by the program to incorporate providers such as dental therapists into their oral health care teams. However, every year since the program’s creation, congressional appropriators have included language in the annual spending bill to block funding for the program. This year, however, the House Labor and Health & Human Services Appropriations subcommittee did not include the language blocking funding in its legislation, which passed the House of Representatives as part of a minibus on July 29, 2021. There are still many things that must happen, including the Senate legislation being released, before advocates can claim victory. However, the House not including the ban on funding in its legislation is an unprecedented step and a very promising sign for Tribes’ ability to benefit from the Alternative Dental Health Care Provider Demonstration Project.

The Indian Health Service (IHS) has worked to expand the Community Health Aide Program (CHAP) to Tribes outside of Alaska for several years. CHAP provides medical, behavioral, and dental services to Tribes in Alaska where the Western health care model has struggled to provide care. CHAP providers often come from the communities they serve, and the success of the program in Alaska led IHS to begin expanding CHAP to Tribes nationwide in 2016.

However, funding the expansion has been easier said than done. For the past two years, IHS has asked Congress for $25 million to expand CHAP, and Congress has only funded $5 million for each year, for $10 million total. In an April 28, 2021 Dear Tribal Leader Letter, IHS announced that it was combining the two years’ funding into one pool to support Tribes and Tribal organizations plan for and implement expansion. IHS will award three $1 million grants to build out existing CHAP infrastructure and nine grants of $520,000 to support CHAP planning and assessment. Funds will be obligated by September 30, 2021.

Each year, the Indian Health Service (IHS), like every federal agency, publishes a Congressional Justification, outlining the priorities of the agency and recommending budget appropriations to Congress. For Fiscal Year (FY) 2022, IHS is asking Congress to fund the agency’s dental line item at $287.3 million, an increase over FY 2021’s enacted funding level of $214.7 million. The Congressional Justification also requests $25 million in FY 2022 for expansion throughout Indian Country of the Community Health Aide Program, which provides medical, behavioral, and dental health services in Alaska Native communities. This funding would support the development of training centers for these providers at Tribal Colleges and Universities. IHS also plans to continue the Tribal Assessment and Planning Grants and the Tribal Planning and Implementation Grants to support Tribes and Area Indian Health Boards that are in various stages of preparation for CHAP expansion.

IHS found that the 2.6 million dental services performed in the Indian health system in FY 2020 represented a 36% decrease from the previous year—this is a quantifiable impact of the COVID-19 pandemic’s disruption of the Indian health system as dental clinics closed for several months to all but emergency care.

Among the agency’s priorities for dental health is to increase the number of American Indian/Alaska Native children with dental sealants and topical fluoride application to increase access to dental care across all age ranges. Evaluation data from the IHS Early Childhood Caries Collaborative, in operation from 2009 to 2017, shows that sealants increased by 65% and fluoride varnish application increased by 68.2% for children younger than six. From 2010-2019, IHS reports that childhood caries decreased by 5% across the Indian health system and untreated decay in children under six decreased by 14%, the first decrease in this area reported documented by IHS.

Currently, Medicare covers only emergency oral health care services. Recently, however, prominent members of Congress have indicated interest in expanding the program to cover regular and preventative dental care. Senate Majority Leader Chuck Schumer (D-NY) announced that the Senate’s $3.5 billion reconciliation package would include a provision expanding Medicare’s coverage to include dental, hearing, and vision care for the program’s 44 million enrollees, including approximately 650,000 American Indian/Alaska Native people. With a closely divided Congress, the expansion of Medicare to include dental and other coverage still faces many hurdles to be enacted.

The Oregon state legislature has passed a bill allowing licensed dental therapists to practice across the state of Oregon, including in the state's Tribal communities. Dental therapists, focused providers who specialize in routine preventative and basic restorative oral health care services, have worked in Oregon as part of a pilot project, including at select Tribal and Urban Indian health organization pilot sites, since February 2016. The new law allows them to practice in Tribal communities and in health settings across the state.

Because each state operates its own Medicaid program, exact levels of coverage can vary. While the federal government requires baseline coverage for state Medicaid coverage, states can choose to go above those baselines or not to. Not every state offers comprehensive oral health care benefits for adult Medicaid enrollees. Maine is one of ten states not to offer comprehensive adult dental coverage, but that is soon to change. In the state budget, signed by Governor Mills on July 1, lawmakers included funding for full dental coverage for the state’s approximately 217,000 enrollees, which includes approximately 7,300 American Indian/Alaska Native people. This benefit will allow Medicaid enrollees in the state to access preventative oral health care, improving oral health and avoiding expensive emergency room dental care.