Tribal Oral Health Newsletter
Issue 15
Summer 2022
The Latest Quarterly News on Oral Health from Across Indian Country
Tribal Dental Therapy News
NIHB Publishes Factsheet on DHATs and the
Indian Health Care Improvement Act

The IHCIA inappropriately requires a Tribe to get permission from its state legislature before hiring a DHAT under the Community Health Aide Program (CHAP). The Indian Health Service (IHS) is in the process of expanding CHAP to Tribes nationwide. Importantly, the limitation only applies to DHATs, and not CHAP’s other providers, including medical and behavioral health providers. The limitation also does not apply to Dental Health Aides, a lower level provider compared to DHATs, so IHS can begin putting these providers in its facilities immediately upon request from a Tribe once CHAP provider certifications begin in the Service Area.

NIHB hopes this fact sheet will be used by partners and allies in the effort to convince Congress to amend the IHCIA, so Tribes need not go through their states to hire DHATs. 
Community Health Aide Program Expansion:
Perspective from the CHAP Tribal Advisory Group
The Community Health Aide Program (CHAP) has created a Tribally led health workforce in Alaska Native communities in medical, behavioral, and dental health. As the Indian Health Service (IHS) expands CHAP to Tribes outside Alaska, it has chartered a Tribal Advisory Group (TAG) to provide Tribal recommendations throughout the process. CHAP TAG is composed of Tribal representatives from each of the twelve IHS Service Areas. The current chair is Councilwoman Sue Steward of the Cow Creek Band of Umpqua in the Northwest Portland Area.

Chair Steward and the members of the CHAP TAG have identified several barriers preventing or slowing the work to expand CHAP. These barriers include:

  • The lack of long-term, sustainable funding for Areas to develop and maintain CHAP certification infrastructure.

  • The lack of agreement on collection and storage of data, with IHS claiming this is an inherent federal function and Tribes pointing to the Alaska Area CHAP Certification Board and self-governance contracts and compacts as evidence to the contrary.

  • The inability of Tribes to add CHAP to annual funding agreements with IHS.

In June 2022, Chair Steward sent correspondence from the CHAP TAG to IHS detailing these barriers and providing recommendations for substantial progress. The correspondence also includes progress reports from the Areas currently working on CHAP expansion.

CHAP TAG meetings are monthly on the fourth Thursday of each month, are conducted by Zoom, and are open to the public. The August CHAP TAG meeting is on August 23, 2022, from 12:30-3:30 PM Eastern.
American Dental Therapy Association Seeking
Executive Director
With nearly 150 dental therapists practicing nationwide, the American Dental Therapy Association (ADTA) has grown in recent years. ADTA’s mission statement is to be a “national network dedicated to improving access and equity for oral health and wellness.”

The organization is now seeking an executive director to manage the organization’s finances and progress toward its strategic plan. The executive director job posting has more information about the position, including how to apply. 
What is the Status of Dental Therapy
in My State?
Use the National Indian Health Board's state legislative tracker to learn more about dental therapy legislation in your state and how you can help make access to oral healthcare a reality for the Tribes!
Third Thursday of Every Month

2:00 PM Eastern

To be added to the invitation list,
contact Brett Weber, Program Manager, Public Health Policy and Programs at [email protected]
NIHB COVID-19 Tribal Resource Center
The National Indian Health Board has developed a Resource Center for Tribes during the COVID-19 pandemic.

Publications include funding opportunities, community health tools, webinars, and other resources to assist Tribal leaders and public health professionals.
Updates from Capitol Hill and the Administration
House Appropriations Committee Makes Progress on Alternative Dental Providers Demonstration Program
& CHAP Expansion
Summer in the nation’s capital typically brings appropriations season, as Congress determines spending levels for the coming fiscal year (FY). The House Interior Appropriations Subcommittee, which oversees the Indian Health Service (IHS) budget, and the House Labor-HHS Appropriations Subcommittee, which oversees the budgets of most other agencies in the Department of Health & Human Services, have both released initial legislation for FY 2023 funding.

The House’s Interior Appropriations FY 2023 committee report includes $20 million for the Community Health Aide Program (CHAP). This program funds frontline medical, behavioral, and dental health providers in Alaska Native communities. IHS is in the process of expanding CHAP to Tribes outside of Alaska. The $20 million proposed appropriation is a substantial increase over the inadequate $5 million appropriated by Congress in FY 2022.

The National Indian Health Board (NIHB) provided analysis of the House’s IHS appropriations overall, including long-sought victories on mandatory spending and facilities leasing. The House’s proposed funding level for the IHS dental health line item is $308 million, a $72 million increase over FY 2022.

Appropriators on the House Labor-HHS Subcommittee gave dental therapy advocates good news, as the FY 2023 bill funds the Alternative Dental Providers Demonstration Program. This program, authorized by section 340G-1 of the Public Health Service Act, would allow states and Tribes to fund dental therapists to fill gaps in the oral health care system. Congress authorized the program in 2010 but has never funded it. Congress considered funding the alternative dental providers for the first time last year but ultimately did not. NIHB joined a group of public health and oral health advocacy organizations calling on Congress to fund this demonstration program.

The Senate is expected to mark up its appropriations packages later this summer.
Oral Health Champion's Corner
This issue’s Oral Health Champion is Kari Kuntzelman, Chickasaw Nation, President of the American Dental Therapy Association!

Kari wanted to be an oral health provider when she heard from people she knew who had had negative experiences receiving dental care. She wanted to be a different kind of provider, one who spoke to patients on their level, empowering them to take charge of their oral health without scolding or judging them. So when she heard about the dental therapy education program in Alaska, it was a natural fit.

Kari enjoyed the first year of classroom learning but fell in love with the potential of her new profession during her second year of clinical learning in Bethel, Alaska. By serving patients in Bethel and the surrounding Alaska Native villages, Kari developed close ties to her patient base. She feels pride in remembering the dental sealant program in the regional villages she implemented.

Kari spent two and a half years working as a dental therapist in her home state of Oregon at the Native American Rehabilitation Association (NARA), serving over 5,000 patients in the Portland metropolitan region. During her time there, she had the freedom to recommend minimally invasive dental procedures, avoiding the drill-and-fill go-to method that patients can find intimidating. Kari also answered the call so many providers received at the start of the COVID-19 pandemic, assisting with vaccination efforts in the community.

In her role as President of the American Dental Therapy Association, Kari hopes to expose more people to dental therapy as a driver of more affordable dental care and as a new potential career pathway for people who have never seen dentistry and similar professions as accessible to them. She also hopes to expand ADTA’s ability to serve dental therapists across the country by growing ADTA’s staff and implementing a three-year strategic growth plan.

Thanks for all you do to keep Indian Country smiling, Kari!
The Latest from State Legislatures
Colorado Becomes Latest Dental Therapy State
Colorado Governor Jared Polis signed S.B. 22-219 into law -- making the state the fourteenth to authorize dental therapy.

Dental therapists are focused providers whose scope of practice includes routine preventative and basic restorative services. In the Tribes that currently employ dental therapists on their oral health care team, dental therapists have reduced wait times, increased the amount of care delivered, and improved patient satisfaction. Dental therapists have worked in Alaska Native Tribal communities since 2004, and in the past 17 years, lawmakers in 13 additional states have enacted dental therapy licensing laws.

Colorado's new law allows dental therapists to practice in certain settings statewide, including dental health shortage areas, Tribal lands, and other underserved communities. The law follows education standards developed by the Commission on Dental Accreditation (CODA): Dental therapists working in Colorado will not have to obtain dental hygiene licenses, nor is there a degree requirement set in the statute. By following the CODA standards, the law allows Tribes in Colorado to replicate Alaska's successful dental therapy model without adding any unnecessary barriers.

The National Indian Health Board’s summary of the Colorado law is available here.
Kansas Increases Medicaid Dental Benefits to Include Adults
Medicaid provides health coverage to nearly 81 million Americans, but not all of these people receive coverage for oral health services. Because Medicaid is primarily a state-run program, states offer different levels of dental coverage in their Medicaid programs.

Federal minimum standards require all states to offer dental coverage to minor enrollees, but not to adults. In the 2022 legislative session, the Kansas State Legislature passed a budget provision to increase Medicaid dental coverage in the state to include comprehensive benefits for adult enrollees.

The National Indian Health Board estimates 21,000 American Indian/Alaska Natives are enrolled in Kansas’s Medicaid program, and the budget provision will expand their access to oral health care services.
Oregon Finalizes Dental Therapy Rules
Oregon passed a dental therapy law in 2021, and the Oregon Board of Dentistry has now finalized the rules and regulations governing the licensure process in the state.

Oregon ran a pilot project for nearly a decade to examine dental therapy’s potential before passing a statewide authorization bill in 2021. The rules require dental therapists to pass a Board-administered clinical exam—even if they have graduated from a competency based accredited dental therapy education program—unless they are already licensed in another state. The rules also allow dental therapists who worked under the state’s pilot project to apply for licensure.

With the approval of the rules having been completed, Oregon can now begin licensing dental therapists. Until a dental therapy education program is established in the state, dental therapists will be trained outside of Oregon.
Funding Opportunities and Resources
Medicaid Adult Dental Benefits: Improving Access for Tribal Populations
Community Catalyst, in collaboration with the National Indian Health Board, the Southern Plains Tribal Health Board, and Native American Connections created a policy brief explaining how a standard dental benefit for adult Medicaid enrollees would improve Tribal health. Read the brief here.
CDC Resources on Oral Health Services During COVID-19 Pandemic
The Centers for Disease Control and Prevention (CDC) has published several fact sheets, guidance documents, and other resources related to providing and accessing safe oral health care services during the COVID-19 pandemic. These documents are entitled “Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response.” Read more here.
Indian Country ECHO: CHAP Learning Collaborative
The Community Health Aide Program (CHAP) ECHO Learning Collaborative is designed to bridge the gap between traditional practices and modern standards of care through bringing together several types of practitioners, including Dental Health Aide Therapists (DHATs), Behavioral Health Aides and Practitioners (BHA/Ps), and Community Health Aides and Practitioners (CHA/Ps). Sessions are open to all, but advanced registration is recommended. Sign up here!
2022 IHS Continuing Dental Education Catalog
The Indian Health Service Division of Oral Health offers several webinars and in person trainings for Continuing Dental Education for dentists, dental hygienists, and dental assistants year round. View the 2022 course catalog here.
National Indian Health Board | | (202) 507-4070
Visit the NIHB COVID-19 Tribal Resource Center at: 
For media inquiries, contact Janee Andrews at [email protected]