The Role of the Dental Hygienist in Alleviating Barriers to Dental Care in Florida

The Associated Press (“AP”) reported on December 2, 2009, that the State of Florida has spent about $2 million defending a class-action lawsuit claiming that Florida is violating federal Medicaid requirements by providing inadequate medical and dental care to more than a million children. The case claims that 750,000 children received no dental care.

The AP reports that many dentists won’t accept Medicaid, because Florida’s reimbursement rates are among the country’s lowest. Medicaid pays $15 for a basic dental exam in Florida, compared to $25 in Tennessee.  Private insurance rates are usually about $40. A pilot program in Miami-Dade County pays dentists a monthly fee of $6.55 to treat each child.  Low rate of payment was cited as the primary reason that dentists did not treat more Medicaid patients.

The AP also reports that Florida reimbursement rates are so low that less than nine percent of Florida dentists are significant Medicaid providers, which leaves a backlog of children desperate for care and very few dentists to see them, experts say.

“Lack of access to oral health care is a critical issue in the U.S. due to disparities in the health care delivery system.  Dental hygienists must play a vital role in the solution to eliminate these disparities and assure quality oral health care for all.”(1)

In addition to financial barriers, there are bureaucratic and legal barriers that prevent dental hygienists from providing access to care.  Numerous sources document these barriers. For example, the inability to pay for care may result from having no dental insurance (one source notes that 55 percent of pre-school age children and 50 percent of school age children have no private dental insurance) or from being ineligible for Medicaid due to income level.(1)

There are also ways that state laws and regulations restrict access to care:  One is by limiting the type of practice settings; the other is by imposing restrictive supervision requirements.  In most states, dental hygienists practice under what is known as general supervision. This means that a dentist has authorized a dental hygienist to perform procedures, but does not have to be present in the treatment facility during the delivery of care.  In Florida, certain procedures must be performed under direct supervision and others by indirect or general supervision. (1)

In fourteen states, dental hygienists can practice under less restrictive or unsupervised practice models. Unsupervised practice means that the dental hygienist can initiate treatment based on his/her assessment of patient needs without the specific authorization of a dentist, treat the patient without the presence of a dentist, and maintain a provider-patient relationship without the participation of the patient’s dentist of record. Maine and New Hampshire have a separate supervision for settings outside of the dental office-public health supervision-which is less restrictive than general supervision. (1)

On October 30, 2009, the Florida Board of Dentistry unanimously passed Rule Drafts (64B5-16.006) allowing preventive remediable tasks, including dental charting, prophylaxis, scaling, fluoride varnishes, topical fluoride, and dental sealants.  If approved by the Joint Administrative Procedures Committee, they will become a Rules change, effectively allowing these services  to be performed in health access settings as defined by s. 466.003 F.S. without the presence or prior authorization of a dentist. 

In addition, legislation authorizing the administration of local anesthesia by licensed dental hygienists who have completed the required training was approved by the Board of Dentistry.  This will require a legislative change and thus, will need to be considered by the Florida Legislature.

Your support is critical to eliminate the barriers that restrict the public’s access to oral health care services provided by licensed dental hygienists in the State of Florida.  Removing these barriers is one way to improve access to the preventive oral services that can avert more costly and invasive dental care. 

• 1. ADHA 2001 Access to Care Position Paper, 2001.

Should you have any comments or questions, please contact Trevor Mask (tmask@cftlaw.com) at Colodny Fass.