With support from an NYSHealth grant, Albany Medical Center has co-located pediatricians at upstate WIC sites to provide oral health services to Medicaid-eligible preschool-age children in areas where access to dental care is limited. At the sites, mothers receiving WIC benefits also are able to bring their infants and children (up to five years old) to the on-site pediatrician for a basic dental screening and a fluoride varnish application—an important tool in cavity prevention.
Noah’s mother, Becky, first learned about the oral health services during a routine nutrition appointment at her WIC site in downtown Albany. Becky’s WIC counselor told her about the free fluoride varnish and asked if she wanted to make an appointment for her son. One week later, Noah saw the on-site pediatrician and underwent the procedure, which was over in less than a minute. Without the WIC Smiles program, “I wouldn’t have known the varnish was in existence, let alone helpful,” said Becky.
Although Noah didn’t have any discernible tooth problems, he had not received any dental care up until his WIC visit. “It’s good to know he has that extra level of protection now, and it’s a good precedent for kids that sets them up for future dental success,” said Becky.
The vision behind WIC Smiles is to reach children at high risk for oral disease before the onset of cavities or tooth decay. “Prevention is much easier because once they have established tooth disease, it’s hard to reverse,” said Melinda Clark, a pediatrician with Albany Medical Center and initiator of WIC Smiles. “The earlier and more aggressive you are on the prevention side, you can make a huge impact in lessening the risk for oral disease in these children down the road.”
The program, which is sustained through Medicaid reimbursement, also helps lower health care spending in the long run: delivering preventive services to the youngest and most vulnerable patients lessens the need for costlier (and more painful) dental procedures later on.
Pediatricians at the WIC sites see infants and very young children whose teeth are just beginning to emerge. In many cases, these patients do not have regular access to dental care because few private dentists accept Medicaid-enrolled children. The pediatricians also are trained to provide families with oral health education, recognize oral health problems in children, and refer patients to a network of dental providers for additional treatment.
WIC Smiles has been established in four upstate counties—Albany, Cortland, Saratoga, and Tioga—and Albany Medical Center is in talks with four other counties to add sites.
Albany Medical Center now also has an opportunity to move beyond WIC sites and have an even greater impact on children’s oral health in New York State, thanks to two major policy shifts in 2014. First, the U.S. Preventive Services Task Force (USPSTF)—an authority on prevention and evidence-based medicine—released recommendations that primary care providers apply fluoride varnish to the teeth of all infants and children up to the age of five. The American Academy of Pediatrics then endorsed the USPSTF directives, releasing guidelines for all pediatricians to perform not only fluoride varnishing but also oral hygiene and dietary counseling as preventive primary care services.
As a result, pediatricians across all payers—not just those accepting Medicaid—can provide the varnish and other oral preventive services to their patients and be reimbursed. “This is now a mandate,” said Dr. Clarke. “You will get paid to do this, and it’s good for children’s health.”
Dr. Clarke recognized the policy changes as a critical moment to move beyond the WIC sites and make a statewide push for a wider standard of care for children’s oral health. She approached NYSHealth staff with the idea to broaden the grant’s original scope of work to include two new key elements: (1) educating pediatricians and other health care professionals across the State on the guidelines and insurance billing changes and (2) training those providers to deliver oral health services.
With NYSHealth’s go-ahead, Albany Medical Center now is working with Community Health Care Association of New York State (CHCANYS) and other statewide and regional primary care provider networks to train providers on how to properly apply fluoride varnish and integrate oral health services into primary care settings—especially in rural health areas where such services have been scant.
While WIC Smiles has improved the oral health of Noah and other Medicaid-enrolled children like him, Albany Medical Center’s collaboration with NYSHealth to expand its grant activities is helping many more children across the State obtain access to proven preventive services.