Dental Hygienists Struggle with Credentialing to Treat Low- Income Population

Current Medicaid law requires dental hygienists who practice independently to be credentialed individually with health insurers which limits their ability to care for people on the Oregon Health Plan.

Some intrepid dental hygienists in Oregon are looking to serve the state’s low-income, non-mobile and rural residents through a state certification that allows them to see patients without a dentist’s supervision.

In Oregon, 468 dental hygienists are permitted to offer expanded practice, according to Stephen Prisby, interim executive director of the Oregon Board of Dentistry.

Dental hygienists with such a permit can practice without a dentist in nursing homes, non-profit health clinics and the homes of non-mobile patients as well as other locations where the population is low-income, meaning the patients earn below 200 percent of the federal poverty level.

The goal is to give greater access to care by reaching patients who might not otherwise have access, according to Prisby. And the need is growing thanks to the Affordable Care Act and Medicaid expansion, which gave greater access for low-income residents to receive dental care, local hygienists said.

Expanded practice dental hygienists can provide their entire scope of care everywhere from schools to prisons to nursing homes and adult daycare centers, according to Teresa Haynes, Oregon Board of Dentistry licensing manager.

Ilya Babiy became an expanded practice dental hygienist, and started his business, On-Site Oral Health Care, just over a year ago because he wanted to “add some variety to my regular clinical practice, where I am not rushed by a full schedule of patients.”

Babiy enjoys the ability to take time with his patients, particularly the elderly and special needs population.

“The need for preventive oral care for the elderly is enormous,” he said. “Many elderly folks may not have the money or stamina to go through extensive dental procedures such as fillings and crowns, but a cleaning can improve their quality of life and how they feel.”

Robin Fatafehi, who started Northwest Mobile Hygiene LLC in April 2013, agreed that many of the patients she sees have lacked needed dental care.

“In many cases most patients whom I have seen while serving and working as an EPDH are 20 plus years old and have never been to a dentist or had a dental cleaning,” she said. “Many of which spanned 10 to 30 years of their adult life without having any type of dental care.”

Besides the regular struggles of running their own business, expanded practice dental hygienists who are trying to be independent are finding themselves surrounded by some unexpected hurdles to provide care and earn money.

"We have to do a lot of work to go through credentialing,” Babiy said.

Fatafehi has a contract with MODA Health, and can provide care to its members covered by Medicaid through the Oregon Health Plan. But some of the low-income patients that these hygienists can treat have their dental coverage through other health plans under the OHP, and that poses a huge hurdle because different plans require a different credentialing process, Fateafehi said. When, for example, Fatafehi visits patients in a nursing home, she can only take care of those covered by MODA or who are uninsured.

Fatafehi and Babiy say it’s time to change the federal Medicaid law and only require expanded practice dental hygienists to be credentialed once before they can treat low-income or non-mobile patients regardless.

"My biggest hope is that there can be a change in the laws for EPDH's now and in the future to be seen as independent and allow for more access to (Oregon Health Plan) funding without the hassle of barriers with credentialing,” Fatafehi said.

Shelby can be reached at [email protected].

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