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States to Watch Oral Health in 2020: New Hampshire and the Adult Dental Benefit

“For the first time in New Hampshire history, we are taking steps to create access to quality oral health care for adults with disabilities on Medicaid and other Medicaid recipients. Dental health is directly tied to overall physical health.”

Governor Chris Sununu said those words in July 2019, as oral health advocates cheered his signing of House Bill 692/HB 4. The bill removed a provision that prohibited a mandatory dental benefit within New Hampshire’s managed care model. The legislation also directs the New Hampshire Department of Health and Human Services (DHHS) to create a designated working group to develop comprehensive adult dental benefits for incorporation into a value-based care (VBC) platform.

The New Hampshire Legislature passed HB 692 with strong bipartisan support in the House and unanimously in the Senate.

Once implemented, the comprehensive Medicaid adult dental benefit will aid nearly 123,000 Granite State adults covered under both traditional and Medicaid expansion requirements. These adults, like those in 13 other states, currently have access to an emergency-only dental benefit. Specifically, recipients in New Hampshire today are only covered for dental trauma, pain relief and infection, and treatment is limited to extraction services only.

How New Hampshire Got Here

For more than a decade, advocates have pressed for a more comprehensive Medicaid adult dental benefit. The New Hampshire Oral Health Coalition (NHOHC) has led this charge and works closely with the New Hampshire Department of Health and Human Services (DHHS), the legislature, health care professionals, insurers, academics and advocates throughout the state to bring about change. These are their keys to success.

Raise awareness of the importance of oral health

NHOHC spent considerable time and energy raising individual and community awareness about the importance of oral health and its connection to overall health. With statewide partners and allies, they examined the barriers and challenges preventing optimal oral health at the micro and macro levels, as well as identified and championed evidenced-based strategies and solutions at local, state, and national levels that improved heath and health outcomes.

Engage traditional and non-traditional allies and champions

Through relationships with partners and allies across the state, NHOHC added depth and strength to their network and increased impact, need and disparities awareness through policy agendas, platforms and advocacy campaigns.

NHOHC also cultivated policymaker champions at the administrative and legislative levels to further advocate for the inclusion of oral health in policy and finance. DHHS led the New Hampshire Oral Health Plan Update in 2015 and the New Hampshire Baseline Survey in 2017. Former Senate Minority Leader, Jeb Bradley, and current Senate President, Donna Soucy, spearheaded the 2015 Pathways to Oral Health Workforce Commission Report which recommended the development of a comprehensive Medicaid dental benefit. Representatives Jennifer Bernet, Polly Campion, Jeff Salloway, Joe Schapiro and Craig Thompson all sponsored HB 692.

Capitalize on the window of opportunity

An important window of opportunity occurred in 2018. That spring, legislation was enacted continuing Medicaid Expansion through 2023. The 2018 elections established a Democratic majority in the House, Senate and the Executive Council. Driven by the experience of her constituents, and following the elections, Representative Jennifer Bernet filed a legislative service request (LSR) – a precursor to HB 692 – to expand the Medicaid adult dental benefit beyond emergency-only coverage.

NHOHC used the convergence of these ‘policy streams’ to educate and demonstrate the impact that expansion of the Medicaid adult dental benefit would have on the population, overall health and on the finances of the state. The result was passage of HB692!

Use clear, consistent, and persistent(!) evidence-based messaging

Educating the state’s 400 Representatives and 24 Senators and keeping them abreast of new information, resources and opportunities has been a primary focus of the NHOHC. Utilizing evidenced-based framed messages developed by the FrameWorks Institute, NHOHC clearly and consistently highlighted why oral health matters to New Hampshire, what factors promote oral health and which undermine it, and highlighted policy solutions needed to improve oral health and overall health outcomes.

NNOHC has been persistent and tenacious in their advocacy efforts and have utilized every format and venue available to reach legislators. In the past year alone, NHOHC conducted education and advocacy events through traditional and social media, written materials, one-on-one meetings, legislative briefings, educational webinars, targeted policy summits with legislative leaders and other state policy-makers, a 30-day oral health education table at the state capitol, and coalition convenings and forums.

What comes next

Much work remains to ensure a comprehensive Medicaid adult dental benefit becomes a reality.

With passage of HB 692/HB 4 and sections 224-227, DHHS has begun convening a workgroup tasked with designing an adult dental benefit that will take effect April 1, 2021. The working group is composed of public and private dentists, hygienists, the state dental society, the New Hampshire Dental Hygienists’ Association, the NHOHC, Medicaid medical managed care organizations, representative members of the Medical Care Advisory Committee, dental insurers and administrators, legislators, and others.

Advocates are enthusiastic and optimistic about the progress made to date. They understand, however that because Medicaid adult dental benefits remain an ‘optional’ service they are constantly threatened by economic downturns or changes in political will.

To ensure that the new benefit is as robust as possible, NNOHC and advocates throughout the state will remain vigilant. They will closely monitor the implementation timeline and assist with benefit design, state plan amendment development, and passage of needed appropriations or other legislation necessary for the implementation of the benefit. They will continue to raise awareness of the importance of oral health and the impact that a robust Medicaid adult benefit will have on the health of individuals, communities and the state as a whole.