Last month, the Centers for Medicare and Medicaid Services (CMS) continued the trend of approving harmful work requirements in state Medicaid programs. Arkansas joined Kentucky and Indiana and became the third state to institute a work requirement. These waivers will cause people to lose coverage, worsen health disparities and harm physical, behavioral and oral health. In response, health advocates, including the oral health community, are pushing back against these and other waiver provisions that put peoples’ health at risk. They are advocating for innovative solutions – within and outside the 1115 mechanism – that are consumer-focused and protect access to coverage and care for individuals and communities.

Despite recent trends, the intention of 1115 waivers is to give states flexibility to try out innovative ways of improving coverage and access to physical, behavioral and oral health care for people with Medicaid coverage. Particularly with respect to dental care, innovation is needed to address significant dental disease and persistent oral health disparities. States have been using 1115 waivers to implement innovative oral health programs for many years and continue to do so even in the face of current threats. For example, California’s Dental Transformation Initiative (DTI) includes a local pilot project that utilizes Community Dental Care Coordinators to provide culturally competent case management and care coordination services in Alameda County. More information about oral health innovation, 1115 waivers and the DTI are available in this webinar recording.

In addition to innovative waivers, many oral health advocates have gotten involved in other creative programs for transforming the oral health delivery and payment systems in their states. For example:

  • Advocates in Massachusetts are working hard to make sure that oral health is incorporated into Accountable Care Organizations (ACOs)
  • Tribal communities, grassroots organizations and advocates in Alaska, Minnesota, Maine and Vermont have successfully organized for the authorization of dental therapists – mid-level dental providers – to practice in their states
  • Advocates in states across the country are working on caries risk assessments and other innovative approaches to reducing cavities in young children

You can learn more about innovative oral health components of 1115 waivers and other opportunities for oral health innovation in this policy brief.