Dental Care for North Carolina’s Special Care Populations Who Are They?



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Dental Care for North Carolina’s Special Care Populations
Who Are They?

  • There is no consistent access to dental care for the more than 200,000 North Carolinians who are homebound or live in nursing homes or group homes.

  • These are individuals of all ages, and they have a variety of complicated intellectual and physical disabilities such as profound retardation, autism, cerebral palsy, dementia, cerebral vascular disorders (stroke), head injuries, multiple sclerosis, and muscular dystrophy.


What Are The Problems?

  • North Carolina has no statewide oral health system to serve patients with special care needs.

  • Nursing home facilities and group homes have few qualified community dentists to care for their residents.

  • State deinstitutionalization policies have put people with mental disabilities into communities ill-equipped to treat their dental needs.

  • Local dental providers are reluctant to treat the medical and behavior needs of patients with special care needs. Nursing home facilities and group homes are challenged to meet each resident’s daily oral hygiene needs.

  • There are no specialty training programs for providers wanting to serve this population.

  • Uncontrolled oral infections result in more costly infections such as aspiration pneumonia, uncontrolled diabetes and endocarditis.

  • Medicaid rates do not keep up with inflation.

  • The two non-profit programs that serve these individuals (Access Dental Care/Carolinas Mobile Dentistry) are stretched to the financial breaking point. These organizations provide comprehensive care to 6400 residents in 13 piedmont counties with an 80% Medicaid/20% Private Pay mix.


How Do We Solve the Problem?

  • Fund the existing models – They work. These organizations have treated 10,500 patients during 56,500 dental appointments and provided 85,100 dental services.

  • Expand the model to another community requesting the program (Asheville, Greenville or the Triangle).

  • Train medical professionals, dental professionals and dental students to care for these individuals.


Partners in Developing a Statewide Special Care Dental Program.

  • North Carolina Dental Society – Funding, treatment of patients and continuing education.

  • North Carolina Council on Developmental Disabilities – Funding and advocacy

  • The Cannon Foundation, The Duke Endowment, The Kate B. Reynolds Foundation, The Moses Cone~Wesley Long Community Health Foundation – Funding

  • UNC School of Dentistry – Training students, treatment of patients

  • American Association of Retired Persons, North Carolina - Advocacy

  • North Carolina Senior Tarheel Legislature - Advocacy

  • North Carolina Arc – Advocacy

  • North Carolina Area Agencies on Aging – Community organization

  • Local and State Calitions – Community organization, funding


Five Mobile Dental Units - Operational Budget




2007-2008

2008-2009

Average Monthly Expenses

$254,781

$292,497

Average Monthly Revenue

Revenue is generated by Medicaid reimbursements, facility retainer fees and expense reimbursements*.



$192,544

$197,382

Total Monthly Deficit

($74,460)

$(95,115)

*North Carolina law prohibits non-profit dental organizations from treating private pay patients. The North Carolina Board of Dental Examiners has required Dr. Milner to create William Milner, DDS, PA when serving private pay patients. Access Dental Care has a contractual agreement with Milner, DDS, PA for use of equipment, supplies, employees, and administrative costs equal to private pay revenue.


2007-2009 Appropriations Request










2007-2008

2008-2009

Existing Programs

Operation Budget


3200 Patients
3200 Patients

This funding will support existing North Carolina non-profits providing comprehensive dental care.

Access Dental Care, Greensboro (10 Piedmont counties)

Carolinas Health Care/Carolinas Mobile Dentistry, Charlotte (3 Piedmont counties)

$357,408

$357,408

$456,552

$456,552

Program Expansion

Capital Budget



Triangle, Asheville or Greenville.

$200,000




Expansion Program Operation Budget

1600 Patients

Triangle, Asheville or Greenville.

$178,704

$228,276

Program Evaluation

5 programs

Complete Program Evaluation in cooperation with the Cecil G. Sheps Center for Health Services Research, University of North Carolina – Chapel Hill

$83,981

$86,655

TOTAL







$1,177,501

$1,228,035


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