The National Indian Health Board has published a fact sheet summarizing the Indian Health Care Improvement Act’s (IHCIA) limitation on Dental Health Aide Therapy (DHAT).

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.

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.

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.

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.