As of January 2022, the U.S. Health Resource and Services Administration has partially or fully designated all 100 North Carolina counties as Dental Health Professional Shortage Areas. This means many North Carolina residents still struggle to find oral health care today.
Medicaid Access in North Carolina
As we enter the summer of 2023, North Carolina is on the brink of finalizing a huge public health victory. The state legislature finally voted to expand Medicaid after more than a decade of hard work and advocacy from countless organizations and individuals across the state.
While the legislation has passed through both chambers of North Carolina’s legislature and was signed into law by Governor Roy Cooper, a provision prevents it from going into effect until all parties agree on and enact a state budget.
Medicaid Expansion became available for individual states to adopt after Congress and former President Barack Obama enacted the Affordable Care Act in 2010. Medicaid is health insurance program for low-income individuals jointly funded by states and the federal government. North Carolina was one of only nine states that had not yet expanded their Medicaid program. An estimated 600,000 North Carolinians will gain access to quality health care once the state legislation goes into effect.
The work toward equitable access to health care doesn’t end with Medicaid Expansion. For people with Medicaid insurance, the oral health crisis the entire state is experiencing could worsen in the short run. Only 35.1% of North Carolina dentists participate in Medicaid. This puts North Carolina 37th out of all 50 states in dentist participation in Medicaid. As more North Carolinians gain access to Medicaid insurance which includes oral health care coverage, our state must work to ensure an adequate supply of dental providers.
The bottom line: Dentist participation in Medicaid, and the many underlying factors that contribute to our current manpower shortage in our already oral health-compromised state, must be addressed. We believe North Carolina residents deserve to have access to oral care, and North Carolina must do better for its low-income and marginalized citizens.
Rural-Urban Divide
More than half of North Carolina’s counties have fewer than four dentists per 10,000 people, an access disparity that skews heavily toward rural parts of the state. In fact, five Eastern North Carolina counties have no practicing dentists.
This forces resident of these counties to travel long distances to receive oral care, making the likelihood of someone going to the dentist for a routine checkup dramatically decrease.
While a routine appointment in Charlotte – which is still inaccessible to many urban residents – could be as easy as a 15-minute trip up the road, a brief wait, and a 30-45-minute appointment, a dental visit in Tyrrell County could include an hour or more of travel time both ways.
For people with children and jobs that make it difficult to take time off, travel time alone can be a significant barrier. Add in access to transportation and consider more intensive oral health needs, such as fillings or root canals that could take several appointments to complete, and you can see how so many who may even have access on paper can’t visit a dentist simply because they live in a rural area.
Movement in the Right Direction
There are bright spots for the state of North Carolina in 2023. During the COVID-19 public health emergency, state level teledentistry policy changes made access to oral health services more accessible for many. People can do check-ups, ask questions, and have follow-up appointments remotely using online virtual technologies..
Teledentisty services lessen the burden of going to in-person appointments for care.
Teledentistry is especially beneficial for individuals who don’t have a dentist in their county, as they can still receive the basic care they deserve without making multiple trips to an office far away.
Spotlight: Bill Milner and Access Dental Care
Bill Milner is a dentist who deserves a spotlight for his work. Access to oral health care is one of North Carolina’s largest issues especially for institutionalized individuals and special needs patients. Milner and the organization he founded, Access Dental Care, are working to fix that. He recently received the 2023 ADA humanitarian award for his diligent work in oral health.
Access Dental Care is a non-profit mobile dentistry organization that Milner founded.
The organization works to bring oral health care to “residents of retirement homes, individuals with intellectual and developmental disabilities, and the community-at-large.”
People like Milner, and organizations like Access Dental Care, are doing all they can to provide N.C. residents with the oral health resources they deserve. While what they are doing is heroic, individual action alone can’t solve some of these system-level problems. There will continue to be a significant need for policy action. Our goal at NCOHC is to create a North Carolina where providers, community organizers, and advocates don’t have to be heroes because true access is the standard, not an anomaly.
