Background:

Nevada ranks 50^th (poorest) in the country in access to oral health care services. Licensure issues have been at the root of this problem for many years. Attempts to increase the number of providers to serve the poorest residents have received resistance in the past. More than one-half of all Nevadans are unable to support the high cost of Nevada’s current dentistry structure and therefore go without services. Costs and access to service have become a monopoly for existing providers.  Typically, the Nevada State Board of Dental Examiners has taken approximately 20 months to implement new regulations which create access for low-income Nevadans to dental services. They use stall-tactics at every juncture, discourage applicants, and provide less than adequate and sometimes incorrect information to applications who desire to provide services.  

SB 133 passed during the 2001 Legislative Session, which opened our state to new dental providers for Nevada’s underserved citizens. Using this bill as a catapult, GBPCA, their members and partners have worked diligently to increase the number of providers for low-income families in Nevada. Unless changes are made in the 2005 Legislative Session, though, crucial aspects of SB 133 are scheduled to sunset this year, thus reducing progress made in increasing access to dental care. Dentists coming into the state will no longer be able to receive temporary licenses that enable them to practice anywhere in the state for two years without taking the dental examination.  

The health center network is one of the largest providers of dental services to low-income families in Nevada. Currently, Nevada health centers receive the same reimbursement rate as any other provider, yet they are one of a handful of places that will take Medicaid and Nevada Check-up patients, as well as persons who are uninsured. This places a high burden on the health centers, as they provide services to persons with little or no income who have no where else to go. Without a higher reimbursement rate, it has become increasing difficult to provide dental services to people without insurance.  

Challenges:

Recent studies* indicate: 

 * Nevada Department of Human Resources, Bureau of Family Health Services and Great Basin Primary Care Association Primary Care Handbook

 Proposed Solutions: 

Families in underserved communities have limited access to affordable dentists, thus making it imperative to recruit dentists who accept Medicaid and Nevada Check-Up to these areas. With a large shortage of dentists in Nevada, most do not see a need to accept Medicaid and Nevada Checkup patients, as they already have a full caseload. Moreover, Medicaid is often slow in reimbursing providers, so most dentists avoid accepting it. Making certain that SB 133 preserves all of its licensing regulations will ensure increased dental access to all Nevadans. Increasing the number of dentists will encourage more dentists to accept patients using Medicaid and Nevada Check-Up since they have a need to increase their caseload. Simplifying the dental licensing process will encourage dentists to serve in areas of need.  

Nevada’s Federally Qualified Health Centers have a Perspective Payment System rate (PPS) for Medicaid and Nevada Check-UP for medical services, which need to be expanded to dental services. This rate is negotiated for each health center and is a formula based on the costs of providing health care. The PPS rate tends to be higher than the reimbursements given other medical providers, and this increased revenue is used to pay for the medical care of those who cannot afford to pay and are not covered by health insurance. Given that Nevada Community Health Centers are the main medical and dental providers to persons without insurance, it is crucial that they earn enough income to cover the costs of proving services to people who cannot afford to pay. A Prospective Payment System rate will ensure that Community Health Centers can continue to meet the dental needs of those without other resources.  

Included Benefits: