According to the Centers for Disease Control and Prevention, untreated tooth decay affects about 25 percent of children aged 3 to 9 living in poverty.1 Compounding the problem, many children enrolled in Medicaid lack access to dental health services and do not receive timely treatment for oral health issues.2
To increase access to oral health care for low-income children, the state of Iowa passed legislation in 2005 that required every child aged 12 or younger who received Medicaid to have regular access to oral health care. In 2006, the Iowa Department of Public Health (IDPH) and their partners created the I-Smile dental home initiative to meet this objective and provide Medicaid-enrolled and Title V eligible children with dental services. The I-Smile dental home initiative uses a team-based approach to dental care; dentists provide treatment and evaluation while other health professionals (such as dental hygienists, primary care providers, and nurses) provide oral screenings, education, anticipatory guidance, and preventive services as needed.
The I-Smile program provides both direct services to low-income children and oral health education to parents and guardians. To fill gaps in dental services, IDPH provides funds to agencies supported by federal Title V monies to hire dental hygienists and nurses to provide direct services to low-income children. To make dental care more accessible, providers also conduct screenings and apply fluoride varnish to children at Women, Infant, and Children (WIC) clinics and Head Start centers.
Another key component of Iowa’s dental home initiative is the 24 state and regional I-Smile coordinators who help families access dental care. The coordinators are dental hygienists who oversee referrals, provide care coordination, and work directly with families to ensure that they get the services they need. In addition to developing local referral systems, some I-Smile coordinators facilitate preventive care at Head Start centers and teach parents about the importance of regular dental care. I-Smile coordinators also conduct outreach activities. For example, they implemented a project that worked in conjunction with hospitals to target new parents.
Since the I-Smile program was implemented, the number of Medicaid-enrolled children receiving dental services increased. Specifically, between 2005 and 2012, 62 percent more Medicaid-enrolled children aged 12 and under received a dental service from a dentist, and nearly 4 times as many children received a dental service from a Title V provider. Going forward, IDPH plans to partner with the Iowa Medicaid program within the Iowa Department of Human Services (DHS) in order to replicate the success of the I-Smile program in other underserved populations, particularly low-income, uninsured adults. In May 2014, DHS plans to launch the Iowa Health and Wellness Program/Medicaid Expansion Pilot to reach low-income adults aged 19 to 64.
Supplemental Material: For more information, read this annual report by the Iowa Department of Public Health