6/11/2010. Oral Health Gains in Health Reform. The battle is won but the fight has just begun! What I ll Cover: Supporting Prevention

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1 Oral Health Gains in Health Reform What I ll Cover:.) Overview of provisions with authorizations for funding 2.) Sources of funding for these provisions 3.) Overview of provisions with direct funding 4.) New Programs Shelly Gehshan, MPP Director, Pew Children s Dental Campaign Pew Center on the States 5.) Q&A Current system and workforce is not sufficient Financing for dental care is likely to grow and will spur demand An estimated 5.3 million more children will have dental insurance due to national health reform The needs are great Shortage and maldistribution of dentists Shortage is getting worse. Too few care for low income, rural patients Dental safety net only reaches 0% of the 83 million who lack access Growing recognition that new providers can competently and safely deliver high-quality care Few private practice dentists participate in Medicaid and CHIP Medicaid rate increases don t solve the problem # of Children (in millions) Children s Medical Care Coverage Medicaid CHIP Private Uninsured* Current After 203 * Illegal immigrants and children from families with income <00% FPL are excluded from the mandate NOTE: In 2006, the number of children without dental insurance coverage was over 5.4 million, according to MEPS Statistical Brief #22 (September 2008) 2 Data from: Kaiser Family Foundation, Statehealthfacts.org, Monthly Medicaid Enrollment for Children, June 2009 (2009) and Monthly CHIP 3 Enrollment for Children, June 2008 (2009). U.S. Census health insurance coverage data 2008 (2009). Federal Interagency Forum on Child and Family Statistics, Health Insurance Coverage (200), The battle is won but the fight has just begun! P.L. -48 authorized new and expanded federal. These are authorized for funding but without specific appropriations. 5-year national, public education campaign focused on oral healthcare prevention and education (Title IV, Sec. 402) Timing: Campaign will begin no later than March 23, 202; campaign planning activities shall begin after March 23, 200 Without further action by Congress, federal agencies might not receive money to carry out these new mandates. Courtesy of New York Times, acting through the Director of Centers for Disease Control and Prevention 4 5

2 Demonstration grants to show the effectiveness of researchbased dental caries disease management activities (Title IV, Sec. 402) Timing: March 23, 200, acting through the Director of Centers for Disease Control and Prevention - information will be used to support public education campaign described in previous slide Requirement that all states, territories and Indian tribes receive grants for school-based dental sealant (Title IV, Sec. 402) Timing: March 23, 200, acting through the Director of Centers for Disease Control and Prevention Authorization: Amended existing authorization to require grants to all states, territories, and tribes 6 Sealant Programs in High-Risk Schools (2009) WA ME MT ND OR VT ID MN NH MA WI SD MI NY WY RI CT PA IA NV NE NJ UT OH IN IL DE MD CA CO WV VA DC KS MO KY NC TN AZ OK AR SC NM AL GA MS No schools have -24% of 25-49% of Expanded cooperative agreements to improve oral health infrastructure (Title IV, Sec. 402) Timing: FY 200-FY 204, acting through the Director of Centers for Disease Control and Prevention AK TX LA FL 50-4% of Authorization: Expansion of existing authorization HI 5-00% of Source: Pew/ASTDD telephone survey of state oral health, June-November, Current CDC-Funded States ( ) WA ME MT ND Demonstrations and evaluation of alternative dental health care providers (Title V, Sec. 5304) OR NV ID WY SD NE MN IA WI MI NY PA VT NH MA RI CT NJ Timing: 5-year program to begin no later than March 23, 202, funding can start in March 20 CA AZ UT NM CO KS OK MO AR IL OH IN KY TN WV VA NC SC DE MD DC ; Director of the Institute of Medicine contracted at end to study AK TX LA MS AL GA FL Funding: Authorized; each grant will be at least $4 million, to be distributed over the life of the 5-year project total of at least $60 million HI Receives funding from CDC to strengthen their oral health Source: Department of Health and Human Services, Centers for Disease Control and Prevention, CDC-Funded States, August 28, 2009, April 2, 200) 0 2

3 2 30 Practitioners Needed to Remove Designation of Health Professional Shortage Area = <0% Ratio of Underserved to Total Population (NH) 5 (DC) Expanded dental training (Title V, Sec. 5303) Timing: FY FY 205 Funding: FY 200: Authorized to be appropriated $30 million FY 20-FY 205: such sums as necessary /Existing (creates a new line-item) = between 0% - 20% = >20% Numbers June = 4, Practitioners 200 Needed to Remove Designation 2 3 New or expanded primary care residency, including dental (Title V, Sec. 5508) Timing: FY 200 Funding: Authorized; $25 million for FY 200, $50 million for FY 20 and FY 202, and such sums as necessary for each fiscal year thereafter. authorization Spending For Federally Qualified Health Centers (FQHC) (Title V, Sec. 560) Timing: FY 200-FY 206 Funding: Authorized; FY 200: $2,988,82,592 FY 20: $3,862,0,440 FY202: $4,990,553,440 FY 203: $6,448,3,30 FY 204: $,332,924,55 FY 205: $8,332,924,55 FY 206 and each subsequent FY: determined from preceding fiscal year considerations Authorization: Amends Section 330b(r) of the Public Health Service Act 4 5 Two Potential Sources of Funding. Funding from the Prevention and Public Health Fund new direct/mandatory funding Sources of Funding Law establishes a fund to provide for a sustained national investment in prevention and public health Will support authorized by the Public Health Service Act, for prevention, wellness and public health activities FY 200: FY 20: FY 202: FY 203: FY 204: FY 205: $500 million $50 million $ billion $.25 billion $.5 billion $2 billion and each fiscal year thereafter 6 3

4 Two Potential Sources of Funding 2. Discretionary funding Top-line budget figure given to the Appropriations committee by the Budget Committee Usually governed by the Budget Resolution Sub-allocations given to the Appropriations Subcommittees Each sub-committee is expected to stay within the bounds of its funding allocation Discretionary vs. Mandatory Budget Spending Projections 200 BR Discretionary 200 BR- Mandatory 20 BR - Discretionary 20 BR- Mandatory 00 Chip Somodevilla/Getty Images $ (in 50 billions) Fiscal Year 8 Sources: Data from House Report -060 Concurrent Resolution on the Budget Fiscal Year 200, (accessed 5//0); Fiscal Year 20 Budget Resolution, Chairman s Mark, Total Spending, Revenues, Deficit/Surplus, and Debt 9 Links to Appropriations Committees Senate Full Appropriations Committee Senate HHS Sub-Committee Programs with Direct Funding House Full Appropriations Committee House HHS Sub-Committee Funding for Workforce Community Health Centers and the National Health Service Corps Fund (Title X, Sec. 0503) Timing: FY 20-FY 205 Funding: Appropriated $ billion to the CHC program $9.5 billion to expand operational capacity and enhance health services, including oral health services $.5 billion for construction and renovation of community health centers Authorization: Amends section 330 of the Public Health Service Act and the National Health Service Corps Funding for Workforce (cont.) Community Health Centers and the National Health Service Corps Fund (Title X, Sec. 0503) Timing: FY 20 FY 205 Funding: Appropriated $.5 billion to the National Health Service Corps Programmatic improvements and placement of estimated 5,000 primary care providers in shortage areas Authorization: Amends section 330 of the Public Health Service Act and the National Health Service Corps Source; National Association of Community Health Centers. Community Health Centers and Health Reform: Summary of Key Health Center Provisions (accessed May 9, 200) 22 Source; National Association of Community Health Centers. Community Health Centers and Health Reform: Summary of Key Health Center Provisions (accessed May 9, 200) 23 4

5 Essential Health Benefits Pediatric Dental Requirement Section: Title I, Sec. 302 New Provisions Timing: January, 204 Secretary is charged with defining the essential benefits package, with a period for public comment Indian Health Care Improvement Section: Title X, Sec. 022 Questions Timing: January, 204 Agency: Indian Health Service Authorization: Amends existing authorization The Indian Health Service can expand the dental health aide therapist model to states where it is authorized under state law 26 2 Shelly Gehshan, Director

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