G-2203-17391

The Illinois Primary Health Care Association (IPHCA) is the community health center association for Illinois, which CareQuest Institute has worked with for about 10 years. Initially CareQuest Institute’s work with IPHCA was through the Safety Net Solutions program and later evolved as a part of the National Oral Health Innovation and Integration Network. As a result of this historic funding and state infrastructure, Illinois has experienced, and continues to experience, a good deal of progress in integrating oral health into primary care.

In 2021, IPHCA implemented two key programs: one focused on integrating oral health and social determinants into the work of community health workers and another focused on building a case to support an alternative payment model related to integrating oral health into diabetes care. Both efforts have continued to advance structural opportunities for integration and efforts to elevate oral health in state policy. In 2021, as a result of advocacy by IPHCA and other partners, the Illinois legislature also approved an extension of the maternal Medicaid coverage to 12 months after the birth of the child. At the same time, the IPHCA 2021 annual compensation and benefits survey highlighted that the turnover rate for all health centers was at a historic 24% and for clinical support positions, such as community health workers, medical assistances and dental assistants, the turnover rate was 30%.

With this in mind, there are two areas of focus for this proposal. The first is the implementation of a “grow your own” dental assistant training program that will support health centers in recruiting and training members of the communities that they serve, in order to have both a health and economic impact. In Illinois, unlike medical assistants, there are limited options for dental assistant training that are affordable and accessible, especially for low-wealth communities. This project will be framed around the National Institute for Medical Assistant Advancement (NIMAA) virtual curriculum and will specifically have a cost associated with it that is accessible to communities that previously have not been able to afford such opportunities. To support implementation, IPHCA will engage community health centers in recruiting from existing staff, existing community members/patients, and from community health workers involved with the pandemic health navigator program that is soon to be closing.

The second focus of this proposal is to implement a Prenatal Oral Health Initiative, that will recruit a cohort of health centers and providing training and technical support for OBGYNs and other prenatal health staff to implement oral health risk assessments, social determinants screenings, oral health education and referral, and apply fluoride varnish. The Prenatal Oral Health Initiative will be modeled off the recent diabetes oral health project in that it seeks to demonstrate a measurable impact on patients and costs of care. Currently, OBGYNs do not get reimbursed for any of the above services when provided to prenatal patients. The intent is to build on recent policy wins in Illinois to continue to elevate maternal and prenatal oral health needs in community health center patient populations. The data from the initiative will be packaged and used to advocate for Medicaid to allow for OBGYNs and other prenatal health providers to be able to bill for the above preventative oral health services.

The budgetary request for this proposal was $150,000. This budget includes only about $28,000 for staff because IPHCA will leverage additional funding from HRSA to cover staff time. There is about $15,000 associated with meeting and learning experiences. The bulk of the budget goes to purchasing the dental assistant curriculum, mini-grants to the FQHCs who are participating in the DA training program and the Prenatal Oral Health Initiative.

The recommendation of the review committee is to reduce the overall budget to $125,000 to be more consistent with historic funding levels. The relationship manager (Parrish Ravelli) had a follow up conversation with the IPHCA and have confirmed that IPHCA does want to move forward if at this budget amount if the grant is approved and it will not impact the outcomes mentioned below.

The IPHCA has a total organizational budget of $22 million, which means this grant represents less than 1% of their total budget.