>> Gabby Duran
Welcome everyone to the Connecting Kids to Coverage
National Campaign Webinar. Our topic today is Advocating
for Healthy Smiles: Children and Oral Health. I'm Gabby Duran,
and I work closely with the Connecting Kids to Coverage team
to support the enrollment of more children and
parents in free and low cost healthcare coverage. February is National Children's
Dental Health Month. So today, we will be focusing on
children's oral health and how you can use the dental coverage
that is part of Medicaid and CHIP to encourage
families to enroll. All children enrolled in
Medicaid and CHIP are covered for dental services. This includes checkups,
x-rays, fluoride treatments, dental sealants, fillings,
and more. Many parents are unaware of
these benefits or how to connect with dentists who accept
Medicaid and CHIP.

Our speakers today will discuss
strategies to promote the dental benefits covered under Medicaid
and CHIP and opportunities to connect children
and families to coverage. Thank you again for
joining us today. We are going to cover various
strategies and tips for engaging eligible families with oral
health messages and information. Our speakers will also discuss
the importance of oral health for children and how your
organization can leverage these benefits when conducting
CHIP and Medicaid outreach and enrollment. We will first hear from
Dr. Lynn Douglas Mouden who is the Chief Dental Officer at
the Centers for Medicare and Medicaid Services who will
discuss the importance of oral healthcare. Next, Laurie Norris,
Senior Policy Advisor for Oral Health at the Centers for
Medicare and Medicaid Services will share ways to promote the
importance of oral health for CHIP and Medicaid outreach
and enrollment.

We will then hear from Donna
Behrens from the School Based Health Alliance,
who will speak to us about school based
oral health initiatives. Then, Georgia Famuliner
will share information about her project,
Smiles for a Lifetime School Based Dental Program. And lastly, Matt Jacob will
share best practices on how to use social media to promote
Medicaid and CHIP enrollment. We will then go over the
Connecting Kids to Coverage Campaign resources,
highlighting our Think Teeth materials and how to use
these materials in your outreach efforts. We will also address questions
at the end of the webinar, so please use your chat box
throughout the webinar to submit your questions to our speakers. Our first speaker
is Dr. Lynn Mouden.

Dr. Mouden again is
the Chief Dental Officer at the Centers for Medicare
and Medicaid Services. Dr. Mouden? >> Lynn Douglas Mouden
Hello, and thank you Gabby, and thank you to everybody
for attending with us today. It looks like we have
almost 200 people involved, so that's great. We certainly appreciate you all
taking time out of your day to address what I think is
an incredibly important topic. But just for fun, we're going to
start out with a poll question. So if you'd go to
the next slide please. So what we want to do is find
out about what you are already doing in your work
with children and families, so if you would please answer
the poll question: How often does your organization
leverage oral health benefits in your Medicaid
and CHIP enrollment work? And if you would please
answer the question. >> Gabby Duran
Sure thing. We're going to go ahead
and launch the poll, so if everyone could choose your
answer that would be great. [ dramatic music ] >> Lynn Douglas Mouden
Okay. I believe that was
about 30 seconds. So can you show us the results? Well we have a lot of
people who said regularly, so maybe after today
it will be always.

So if you would please
go on to the next slide and we'll kick things off. So what I wanted to talk about
today is the importance of oral health to keep
the dental focus on this. In the late 1990s,
I was on the advisory board for a similar program when I was State Dental
Director in Arkansas. I have been working on this
for a very long time. And since I know there
are some non-clinical types on the webinar today,
I don't mean to gross you out with the pictures,
but you need to understand the importance of what it is
we are talking about. When I was in private practice,
I can't tell you how many kids I had that came in having
no idea how many days they'd suffered a toothache,
and then once they were anesthetized,
once they were numb, they would go sound asleep
for the procedure because it had been so long since
they'd been comfortable.

So you need to understand that
dental caries, tooth decay, is a transmissible disease. Children get literally
inoculated with the infections bacteria, typically as infants,
by the caregivers. So it's often mom, dad,
or the babysitter that are actually giving their bacteria
into the child's mouth. So this is most serious when it
develops as something we call early childhood caries, or ECC,
where this already starts to show as an infections
process before the child is even three years old. Unfortunately, we still see
nationwide surveys that about half of kids have
a cavity or carious lesion by the time they turn five. And even more interesting
I think is the fact that many surveys,
including the ones we did in the state of Arkansas and
when I was in Missouri, that about 10% of the kids
that we examined in the school setting had
emergency dental needs.

One out of ten was sitting there
either with a toothache or some other infection in the mouth
that was obviously causing them problems at school. The problem we had,
especially with early childhood caries in children,
tooth decay, is that it unfortunately
is an infection that is virtually impossible
to stop once it's there, and therefore they have the
propensity for having tooth decay throughout their life,
which is why we are always concentrating so much
on early prevention.

It's amazing what some of
these kids put up with. Children with tooth decay,
abscesses, other infections, have trouble eating,
sleeping, learning. It's, as you can well imagine,
it's virtually impossible for these kids
to concentrate on anything. What we do know is from studies
that early childhood caries, when these children have
to go to the operating room, can run as much as
$9,000-$15,000, and the study that was done
most recently in the state of Massachusetts showed that
so often these kids are back in the operating
room within two years, even after the
successive treatment.

Next slide. Why is it so important
to what you are doing in Connecting Kids to Coverage? First of all,
please understand that virtually all tooth decay
is preventable. It is an almost totally
preventable disease. It is an infectious process. And unfortunately,
it is not equitably distributed in that we often see,
and these studies go back many years, that almost
80% of the disease is found in just 20% of the children,
and this obviously most often affects our Medicaid
beneficiaries. As I mentioned, it's impossible
to concentrate in school or to do your homework with
a child that has a toothache. And we know from this study,
which is a few years old, almost six million school hours
are lost each year due to various dental problems. Lack of access to care,
as we see over and over again, when you ask communities and
Medicaid beneficiaries about what it is they perceived as
their most important needs, often dental care is cited
as very top of the list. So it's important to us,
it's important to us as dentists, it's important
to us as Medicaid programs, and it's obviously important
to children and their parents.

So again, I thank you
for being with us today. So with that, I'm going to turn
it over to Laurie Norris. Laurie is an attorney
with CMS and one of our advisors and deals with oral health
and other issues. So, Laurie? >> Laurie Norris
Thank you Dr. Mouden, and good afternoon everyone. Next slide please. So Dr. Mouden has just given us
a list of very good reasons why we are focusing on this today. I wanted to give you one more. It's interesting to note
that dental coverage is valued by parents. Parents, it turns out,
want to be able to take their children to the dentist,
but because of a historical separation of medical care and
dental care and between dental insurance and medical insurance,
parents don't automatically assume that dental coverage
comes as part of the Medicaid or CHIP coverage that they're
signing their child up for. So what we see on this slide
is that in a recent survey, 68% of parents said that knowing
that dental care was part of what they were going to get
for their child was one of the top five reasons for signing
their child up for care.

So it will make a difference for
you to use dental services as part of your outreach messaging. Because parents
really do care about it, it is important to them,
and they don't automatically assume that that's part
of the package. So let them know that
as you are talking to them and outreaching to them. Next slide please. So let's just take a quick look
at where children get their dental coverage today,
and these numbers are about a year old.

I apologize, it takes a while
for all of my data sources to catch up with each other. But what we can see here is that
the vast majority of low income children receive dental
coverage through Medicaid, 42 million children in 2015. A significant number received
dental services or dental coverage through CHIP,
8.4 million children. And even though
the Affordable Care Act is certainly very important,
a relatively small slice of kids,
about 900,000 kids, get their dental coverage
currently through the Affordable Care Act plan. Next slide please. So I wanted to take a moment
to familiarize you with what is covered as part of the dental
benefit in each of these three types of coverage. And this time we are going
to work left to right. We're going to start
with the Affordable Act. Pediatric dental care
is considered an essential health benefit,
but the scope of that benefit varies by plan. There is not a specific scope
that is mandated in the law. So what is covered
varies by plan. In addition to that,
cost sharing is allowed, but there are limits on that,
and there may not be any annual or lifetime maximums in an
Affordable Care Act dental plan.

One of the most cumbersome parts
of the Affordable Care Act dental coverage for kids is
that sometimes these dental benefits are embedded in
the health coverage that a parent purchases,
or sometimes parents have to purchase a standalone
dental plan. And this complexity is one of
the reasons why some children are not actually getting dental
coverage when they do have medical coverage through
the Affordable Care Act. So going to the middle column,
in CHIP, dental coverage is a mandatory part of the benefit. And it's a fairly robust
scope of benefits. What is covered is dental
services necessary to prevent disease,
promote oral health, restore oral health structures
to health and function, and treat emergency conditions. In CHIP there can
be cost sharing, but that varies by state. And then in Medicaid,
this is the most comprehensive coverage. The coverage is again
mandatory for children, and really the coverage must
cover everything from screenings to whatever dental care is
necessary to treat a dental condition that a child has. Also, there is no cost
sharing or annual or lifetime limits permitted.

So we have really terrific
coverage available to kids in Medicaid and CHIP. Next slide. Our challenge is
to get them enrolled, and then once they're enrolled
to get them to use the coverage. And this is just to give you
a snapshot of how many children are actually using their
dental coverage once they enroll in Medicaid. And what you're looking at here
is 15 years' worth of data, starting in 2000
and going to 2015. And we've broken the data out
by three different types of dental services. The top line, the blue line,
is any kind of dental service all rolled up into one. So this is representing
children who went to the dentist for anything. And you can see that in 2000,
we started, we were at 29%, fewer than 1 out of 3 kids
was getting a dental service back in 2000.

And there has been steady
improvement. As of 2015, we were up to 50%
of our children getting some type of a dental service. The red line is preventive
services. These are things like cleanings,
fluoride treatments, and sealants. And those are running neck and
neck with any dental service. So we can infer from that that
most of the time when a child goes to the dentist,
they get some kind of a preventive service. And the green line shows
how many children received a treatment service. And while there has been
improvement since 2000, it really has levelled off
in the last five years. We're not really sure how
to interpret this data. We don't know whether that's
a good thing because more children are getting preventive
services and they have less disease and less need
for treatment, or does this mean that there are
still a lot of kids out there that aren't getting
the care that they need.

So I call this my good
news/bad news slide. The good news is that we are,
more and more kids are getting, are using the benefit,
are getting in to the dentist, are getting the services
they need. But we still have a lot
of room for improvement, we're still only reaching
half of our kids. Next slide please. So we at CMS pay a lot
of attention to this. We really care about whether
kids can actually use the benefit that
they've signed up for.

And so we launched
an oral health initiative. We set a goal for ourselves of
increasing by ten percentage points the proportion
of children who received a preventive dental service. And when we started
this in 2011, our national average was 42%. So our goal was to improve
that by 52% of kids. As of 2015, we had inched up by
four percentage points to 46%. So like I said earlier,
we're making progress but not enough. So we still have quite
a ways to go. In addition to setting a
national baseline and goal, every single state has
its own baseline and goal. And on the next slide,
we can see how the individual states are doing. I though this might be
of interest of you, to find your own state on this
graph and see whether your state is up towards the left and is it
one of our higher performers, or maybe your state is down
towards the right and is one of our lower performers. I know we have grantees on
the line from Texas, and obviously Texas is our
highest performing state right now with about 66%
of children getting a preventive dental service. I also know that we have folks
on the phone from California and from Florida,
and you can see that those two states are down more
in our lower performing group.

So we still have a lot of work
to do in quite a few states. Next slide please. I thought you also might be
interested in learning that we do have some good news over
the last decade in terms of disparities and closing
the disparities gap in terms of access to dental care. And what this slide shows,
let's look at the left side of the slide first. What this slide shows is that
we have essentially closed the race and ethnicity gap
between 2000 and 2014 in access to dental care. In 2000, white children,
about 75% of white children were getting a dental visit,
but only 67% of black children and only about 57% of
Hispanic children.

But by 2014,
everybody had improved. White children were up to 80.5%,
but black and Hispanic children were inching up right
behind them, 79% and 78% respectively. So that is really terrific news. In addition to that, if we look
at the right side of the slide, another place where there has
historically been disparities is around source of insurance,
that kids with private dental insurance have tended to see
the dentist more frequently than kids with public
dental insurance. And data, a study that
looked at 2012 data, after adjusting for demographic
and parent characteristics found that there was no longer any
difference between public and private insurance as
the parent reported use of dental care by children. So that is super exciting
as well. However, on the next slide,
I also have some not so good news on disparities.

So while we've seen that kids
are going to the dentist at least once a year,
approximately equally, their oral health status,
how healthy they are, is not yet equal. And so again, on the left,
the race and ethnicity disparities are still pretty
significant. This is looking at data from two
decades, data a decade apart. And let's just look at
the 2011-2012 data. 15% of white children had
untreated tooth decay in the 5-9 age group.

Only 15% of kids. But 24% of black children had
untreated tooth decay in this age group, as did
24.5% of Hispanic children. And again, this is
an improvement from the 1999-2002 survey,
but there are still disparities. And American Indian and Alaska
Native children suffer the most from this disease and have huge
untreated tooth decay rates as you can see in the bottom
row in this table. It's a different age group,
it's even younger kids, ages 2-5, and yet the untreated
decay rates are really quite significant. We also have disparities in
terms of household income, in terms of untreated
tooth decay similar to race and ethnicity. The lower income you are,
the more likely you are to have untreated tooth decay. So we still have more
work to do. So to close out my part of
the presentation today, if you'll just go
to the next slide. Just a few tips on how
you all can help. What we're really emphasizing
is for you to remember to talk about dental coverage
during your outreach, because parents highly value it. And we'll be talking a little
bit later about the campaign resources that are available
to help you do this.

In addition, when you get to
the enrollment stage, remember, please please please,
to tell parents that part of what comes with their coverage,
in addition to medical is also dental, and by the way,
also vision coverage. And we have campaign resources
that we'll talk about later that will help you with that as well. And then lastly,
to the extent you have an opportunity to help
parents connect to care, we have a terrific and easy way
to do that through our Medicaid and CHIP
National Dentist Locator. And I will show you what
that looks like when we get to the end today. And it's something that
you can post on your website and help parents use,
or just tell them about it and they can use it themselves. So that's it for me
at this point. Thank you very much
for your attention, and I'm going to turn it
back over to Gabby. >> Gabby Duran
Thank you so much Laurie and Dr. Mouden for sharing how
CMS helps children and families get enrolled and connected
to oral health services.

Our next speaker today
is Donna Behrens. Donna is a Director of School
Oral Health Services at the School-Based
Health Alliance. Donna? >> Donna Behrens
Hi everyone. I'm so happy and thrilled
to have been invited to talk about the School-Based
Health Alliance's School Oral Health Project. As Gabby said,
I'm Donna Behrens. I direct the School Oral Health
Services of the School-Based Health Alliance, and for those of you
who may not be familiar with the School-Based Health Alliance,
it is a non-profit organization. It was founded in 1995 and
serves as the national voice for school-based health care,
working to improve the health of children and youth by
advancing and advocating for school-based health care. So working in the space
of school oral health has been just a wonderful fit
for our organization. So we're very excited to talk
about a project that got funded. We just started our third year
of the project. It was funded by the DentaQuest
Foundation and was one of the Oral Health 2020
Network Goals. It was one of the 2020 Oral
Health Goals to incorporate oral health in school systems and the
DentaQuest Oral Health 2020 Goal targeted the ten largest school
districts in the United States.

We were pleased to get
additional support from the Duke Endowment in
the second year of our work. So we were able to include
not just the ten largest school districts,
but school districts from both North and South Carolina. You will be hearing in a little
while from one of our community partners in South Carolina. Our goal for the project was
really to create a respectful shared learning space,
to be able to work with the school districts to create,
innovate, strengthen, and facilitate systems so that
they could better incorporate oral health services
into their schools.

We really believe in working
with the schools and their community oral health partners
that there is a real opportunity to change the trajectory which
you heard and saw for children who for no reason are suffering
from unaddressed health issues, be able to provide some
really needed intervention, prevention, early intervention
to create the connection to community based providers and
certainly to educate a new generation on the importance
of the school of oral health. Next slide. So I did want to talk
very briefly, and Dr. Mouden already
touched on this, is why focus on schools? And besides the statistics
that are on this slide, I think the things that
stand out the most to me, and again Dr. Mouden
already said this, is that 60% of children are
affected by tooth decay, which is an infection. And it makes it one of the most
chronic childhood diseases. Also, I think the other study
that really stands out for me always is that children with
poor oral health were nearly three times more likely to miss
school because of dental pain.

And just, these are kids that
are at risk at not succeeding in their school career,
and anything that we can do that can keep them in school ready
to learn is really, really critical. Next slide. On the more positive side,
schools, it's a really important time when kids are learning
health behaviors. It's a time when you can really,
they are open to changing their beliefs or their attitudes,
they are receptive. You can really reinforce
health messages.

And I want to believe it is
a time to help kids really learn to make good,
healthy decisions and be taught good health behaviors. And oral health really needs
to be front and center along with a lot of the other
health behaviors that get talked about in schools. The next slide, I'm just,
I hope to very quickly go over what we have been doing in our
two years of work as we've tried to help integrate oral health
in schools across the country.

We spent our first year really,
we call it our foundation building year. We really were out there
listening, learning, and developing relationships. We needed to understand what is
already out there in our ten largest school districts. We needed to understand not just
what they were doing but understand the unique political
policy and funding environment that each of our school
oral health programs were operating in,
and then we needed to learn more about the schools themselves,
providers and parents. So what did we learn? And I'll just very
quickly talk about this. I think probably what stands out
the most is that we were connected to some of
the most devoted, passionate, and committed people who are
working day to day in schools to try to improve the oral
health of the students. They are great programs,
great services, real energy and perseverance,
and they all bring a can-do attitude to their work. We also saw a lot of challenges
they are up against in terms of really being able to expand,
strengthen, and bring to scale school oral health.

One of the first things
we learned, and this gets back to some
of what we heard the two previous speakers talk about,
is actually getting parents to sign consent for
the kids to receive their oral health services. They could have the best
programs in the world, but if parents don't say yes,
then the kids, even with the service in the schools,
don't have access.

We learned that when
you say school oral health, when you say that out
in the field, there is not always a lot of
clarity and alignment about what you are talking about when
you say school oral health. For some people
it's a sealant program, other people it is
oral health education, others it can be screen
and fluoride varnish, and others are
offering the full compendium of services that provide
treatment and limited restorative care on site. We also found that
meaningfully engaging with families can be a challenge. Some of it is that families
are very stressed for time. Their connection to schools
is often tenuous, and when school oral health
programs are coming into a school for just a week
or two weeks during the year, that making those
connections to families can be really challenging. Also working within the cultural
and language barriers in families and trying to overcome
some of the lack of awareness of the importance of oral
health prevention services. We heard that case management
is a challenge and trying to connect families to community
based providers, find community based providers
that are willing to treat students with Medicaid
or who are uninsured, and a lack of transportation.

We heard of funding
and sustainability, there is just really limited
funds to bring good programs up to scale. There are all kinds of policy
restrictions, reimbursement restrictions on who can be
reimbursed and where services, reimbursable services,
can be delivered. So school based oral health
programs are up against a lot of those challenges. And then collection of data
and outcome measures. There are no uniformly
adopted outcome measures for school oral health. Data is collected in
a variety of different forms. Making that data available and
having comparable data across programs has been a challenge. So when we finished
our first year, we approached the school
districts and seven of the ten expressed their
interest in participating. And as I said,
we were very fortunate to have the Duke Endowment also approach
us about including a total of five school districts from North
Carolina and South Carolina, and we have a team
that we are working with, one from South Carolina,
one from North Carolina. Next slide. When we began our year too,
we began this serious work of what we called prelaunch work
for our learning community, and then moved very quickly
into launching.

Again, we talked about
creating that space and support for a learning community. We were again, we have twelve
school districts and nine teams that are working with us,
and our prelaunch includes creating topic specific webinars
around all of the levers that could increase consent
rates from parents in school districts,
and that became our learning community's outcome measure
that was shared across all our school districts. We also convened in school
groups to talk about the policy and sustainability issues. We are working currently with
a national group of stakeholders to create an online one stop
shop compendium of school-based oral health tools,
resources, information, and probably most importantly
all of those critical links to national, state, and local
sites that have information, resources, and tools. Our data is ready to go,
our national group is taking a look at it now,
and we're really excited that our goal is to have that up
and running by early spring.

And we are also convening around
creating consensus around what is meant when one says
school based oral health. Next slide. I used the word
learning community. I just want to say that there
are a lot of similar endeavors. Some are called COINS,
some are called learning collaboratives,
some are called PIPs. There are lots of models of how
to create this shared learning community or shared groups. We actually went through
the IHI Breakthrough model, and we had to adapt it since
school oral health does not have established best practices
or outcome measures. So in adapting it,
we again chose the shared metric of increasing consent,
knowing that to increase consent would require engagement
with schools, teachers, school leadership,
engagement in communities, engagement with parents,
and communication and marketing.

We are using the
Plan-Do-Study-Act, we are doing small, quick,
observable changes. We have a data portal where
all our school districts are uploading their information. We are doing monthly calls with
everyone one on one as well as a group call every month in
order to facilitate the sharing. The next slide. We are working with
Chicago Public Schools. We are working with
the Clark County School District which is in Nevada.

We are working with
Hillsborough County Public Schools in Florida,
the Houston Independent School District, Los Angeles
Unified School District, the Miami Dade County Public
Schools, the New York City Department of Education. And additionally we are
working with, in South Carolina, Welvista, it's Clarendon School
Districts 1 and 2 as well as Allendale and Dillon
School Districts. And then Montgomery
County Public Schools in North Carolina. So we're really excited,
this has been a great year. We've learned a lot. We have internally in our own
group been going through our own PDSAs as we've been refining
our learning community, and we've been learning from
all of our different partners. So the next slide is a visual
of the amount of networking that's been going on,
the strengths of the connections
between our groups.

Again, we have been defining and
aligning around the components of school oral health,
and I'm happy later if anyone would be interested in talking
about or sharing what those components are. We have our school districts
that have gone through a launch. We came together as a group
with national and school district members,
around the goal of the school oral health in September,
and we are going to be reconvening in June. We've got a Basecamp data
portal and a school oral health repository of resources
soon to be launched. So we're really excited about
the work we've been able to do. We are very happy to have
had the support again of the DentaQuest Foundation,
the Oral Health 2020 Network, and the Duke Endowment. And I just want to close
with our mantra, and we say this often
and we say it frequently. If you want to go
fast go alone, if you want to go
far go together.

>> Gabby Duran
Thank you so much Donna for walking us through the work
that you all do at the Alliance to bring together
school-based groups through your learning community. That is a great message
to end on as well. Our next speaker today
is Georgia Famuliner. Georgia is the Operations
Director for Smiles for a Lifetime. Georgia? >> Georgia Famuliner
Thank you so much. I appreciate the opportunity
to talk with you all today and hopefully I will share some
great information about what we're doing at our Smiles for
a Lifetime Program, and you can take away some
good ideas.

I am Georgia Famuliner,
and we started the Smiles for a Lifetime Program
16 years ago in South Carolina. In 2001, we opened the centers
to provide care in rural areas of South Carolina. The organization, Smiles,
is owned by a nonprofit based out of Columbia,
South Carolina called Welvista. And I am delighted to be a part
of Donna Behrens' learning community with the School-Based
Health Alliance. We had that opportunity
through our original funder, Duke Endowment, that opened
all four of our centers. We found out about the School-
Based Health Alliance and asked, even though South Carolina is
not one of the largest school districts in the nation,
could we participate as we have had this ongoing
dental program for 16 years. And they were gracious enough
to accept us, it has been a fabulous
experience for us to be able to learn and share with
other districts in the nation. Next slide please.

So we are located, as Donna
said, in Allendale County, Dillon Four, Clarendon 1
and 2 School Districts. Originally, when we opened
each one of these centers, we did initial screenings
in the school, and all the children
were screened. Depending on what
district it was, overall there were 74-76% of
the children that we could see in the classroom with penlights
had oral decay in their teeth. So we had our work
cut out for us. We opened the programs with
basically the four centers right now are comprised
of about 9,300 students in those four districts. We are serving 40% of those
students as of last school year. We provide preventive and
restorative services, and we are open to any child in
grades K4 through 12th grade. We do focus on that prevention
and early intervention based on the premise that we feel like
children must be healthy in order to be ready to learn. Our model created through a
public/private partnership that provides children from limited
income families with affordable and effective health care,
oral health care, and also the education piece
that we provide to these children to learn how to
take care of their teeth.

We accept Medicaid children,
children that have private insurance,
and we see those that have no source of pay at no cost
to the parent. So no child that needs
a service with Smiles for a Lifetime is ever turned away. Next slide please. I was asked today to talk
about some of the things the Smiles program does,
and two of the large things for us.

The new thing this
school year has been outreach. In the past we have never had
outreach workers in our centers. And so that is a new
program for us. It began this school year
in an attempt to get additional consents obtained. And that is one thing from being
part of the School-Based Health Alliance and sharing
information across the nation, that is our focal point. All of us have
had problems getting parents to sign consents. So putting outreach workers in
the schools or in our program allows that person to go into
schools through any type of back to school event, PTO meetings,
health fairs and such, and really be a liaison between
our program, people out in the community, schools,
teachers, grandparents. It's really amazing just the
connection in small communities, how many people are either
related or know other people that can hook us up if we know
a child's name with someone who can reach a grandparent
or someone to try to sign a consent.

So it's been very valuable
for us to have outreach. It really allows us to also help
that parent fill out a form. Some of our people
in these communities have difficulty reading. Some of them can't write well. So often times our outreach
workers will fill out the form and have the parent sign it
as they go through each line explaining what
the form is comprised of. The outreach is done
via telephone, and it is done in person. And in these small rural
areas that we're in, transportation is
often an issue. So if someone does not
have a car, then often they may live near
some sandwich shop or Subway or Hardee's or something like that
and they can actually walk to that location and meet an
outreach worker to be able to get that paperwork filled out. We blanket the schools on
the first day of school with consent forms. So every child gets a form
on that first day of school.

And then about four to six
weeks after school starts, we start that process
all over again. The schools give us rosters
so we know who the children are in each classroom,
and then from that point on we will actually fill in a
consent with a name and send it back to that classroom,
trying to get the teachers to get those forms continuously
home at least every four to six weeks during the school year. And then in the meantime,
that outreach worker is taking charts from previous words that
we haven't gotten consent on that we have seen in the past,
and she's working those charts to continue to call parents
and try to pick up that extra link for us.

We had some great
outreach efforts this year. One of them was a recent meeting
that we invited the community ministers to come into
the school district. We gave them information,
gave them blank consent forms to take back to the congregations
to talk us up in their churches, and any child that did not have
a dental home they would encourage those parents to sign
their child up with Smiles. We've also got a Smiles
Ambassador Program that we're starting in
the Allendale district. We just sent the letters
home to the parents. We had 18 children that were
chosen by guidance counselors from the Midland High School. And we're going to have a
student driven task force that is going to do some surveys
in the school asking children if they go to the dentist,
why don't they.

One of the areas that
we have found most difficult is trying to get teenagers to sign
up to go to the dentist. Lots of factors,
some of them fear injections, some of them it
is peer pressure, they don't want to be seen
getting in the Smiles car to come to the center. Some of it is just having
extracurricular activities and not wanting to be numb,
don't want to go to basketball or football practice. And so our center does
operate during school hours. We have a car and driver,
we are located on a school campus so they pick up
the kids and bring them here during school hours. But the high school
is a hard area for us. So we are hoping that students
talking to students will be a great ambassador program to
have the ones that do come to us encourage those that don't
through maybe in-school poster campaigns,
the surveys we talked about, doing some per grade
pizza parties, just different ideas
that the students come up with for enrollment. We also had a great teacher
incentive program at back to school where any elementary
teacher in kindergarten through sixth grade that got 100% of
their class to bring back their forms got a $50
gift card from us.

That doesn't mean the children
have to come to us, it just means that that form
has to come back, either coming to us or showing
that they are going to another dentist or they just don't want
their child seen here. But we had great
participation with that, because the teachers got
very involved and were very willing to help with that. Next slide please. Gabby, I'm not sure if you
can hit – there we go.

So here again, that's one of
our outreach workers. This past school year
we saw 3,677 children, which was 40% of
the school population. 93% of the children that
we serve have Medicaid. Since opening 16 years ago,
we've seen almost 15,000 patients,
and we have filled over 88,000 cavities,
which basically rounds out to about every child
having six cavities. We've gotten,
as I spoke about this being a new program for outreach,
I think so far we've seen some success from October 1 when
we sent home the second set of consents through January 31,
the four centers have obtained 660 consents due
to outreach efforts.

So we're pretty thrilled
about that. Next slide please. The other area that we are
really focused on is what we can do to get children
signed up on Medicaid. As 93% of my children
have Medicaid, are eligible, or have had a Medicaid
number in the past, we know from time to time
in South Carolina they have to go and re-up and re-certify
and sometimes parents, the paperwork can be
a little intimidating, taking in information to prove
eligibility can be more than some of the parents
want to take on. So we actually have one person
that is a collection specialist that is on our staff. She is housed in the Allendale
office but she works for all four of my centers. Her task is to basically
track Medicaid and private insurance eligibility,
striving to get payment obviously for our office
for services for Medicaid. But she works with parents
to explain that process, to help them know exactly what
they do to go and sign up their child for Medicaid and
get through the process.

We devised a demographic form
which I'll show you in a few minutes, but it's just a simple form
that we get off the information that a parent sends back
on our consent form. It is for children that are not,
when we look them up they do not have an eligibility for
Medicaid right now or there is no source of pay,
they don't have private insurance or Medicaid. And they will fill out
the child's name, social, parents' names,
any phone numbers and addresses, and then if the parent said on
the consent their child had Medicaid they will list
that number.

If the parent said that
the child had insurance they will list that
information. And they fax those in
to our collection specialist. She takes that demographic form
and verifies that information. We have found over time that
some parents will put down, for instance,
they think their child has Aetna Dental coverage,
and when our collection specialist actually goes and
looks that up they have Aetna but it's medical coverage. So parents don't always,
are not always aware exactly of what insurance
coverage they have, and they can get a little
confused about that. So she goes in,
looks them up on our South Carolina Medicaid website,
and verifies whether indeed they are terminated
or they are eligible. Then she will call
the parent and talk to them about her findings. She will ask them if someone
puts down that they don't have private insurance,
and she finds out that they actually could,
she will either ask them to go in open enrollment when that
time comes around and sign their child up. If that person does not have
the money to pay for insurance on the side,
then she encourages them to sign up for Medicaid.

And of course on our Medicaid
website in South Carolina, it will show you a third
party carrier. So if a patient does not think
that they have their child signed up on their
insurance at work, we can see whether it is Blue
Cross or Aetna or Delta Dental or whatever it is showing up
on the Medicaid website. So those are all things that
she would call and discuss with that parent.

She works with them very
closely to talk about, so many things have changed in
the Medicaid process of trying to get children signed up. So even though parents sometimes
think they make a little bit too much money to be
eligible for Medicaid, it's always worth that effort
to go and try to apply because things do change over time. And we've found that people
who couldn't get it in the past now can get it. So she uses that form to make
connection with that patient, hook them up with a caseworker
at Medicaid doing whatever she can to get
that person signed up.

And it takes a lot
of effort here. I think that person
has been very, very valuable to us getting
children back on Medicaid. In emergency care situations,
sometimes children come in and don't have Medicaid but
they have a dental emergency, she can hook them up
with Medicaid. There is a limited emergency
coverage that they can get rather quickly. Often times, people are very
transit in these rural areas, so we have people
who move in from out of state. They may have Medicaid in
New York or some other state. Then she goes through
with that parent, explaining that they will
not be able to use that Medicaid in our state,
they will have to close it out in the state that they moved
from and re-apply into South Carolina. So she helps them
with that as well. It takes about 45-60 days
to process Medicaid, so she will continue to look up
after about three weeks to see if that child has Medicaid.

If not, she calls that parent
back again to just touch base with them,
to ask them if they applied. If they have not,
she will encourage them again to go through the process. If they have applied but
haven't heard anything, she will ask them to contact
their caseworker just to ask and see where they are in
the process of getting that. One of the large things for us,
and a way that we really go after working to get
these children on Medicaid, is to explain,
and I saw this earlier in the slides from some
of the other presenters, is really explaining and
encouraging that parent to understand,
not only does the Medicaid benefit help them get dental
coverage for their child, but it also is going to cover
prescription drugs, if their child has to go to
a hospital or for an ER visit on a weekend with an earache
and there is no doctor's office open.

If they do go for wellness
checkups or for sore throats to a regular physician's office,
their eye doctor visits, and any other medical provider
that they go to that is covered under Medicaid,
that will help them as well up to the age of 19. So it really benefits all
of us to get these children on Medicaid. Next slide please. This is the self-pay
demographic information sheet that we made up,
and at the end of my presentation I do have
my email address on here, so if there is anyone that could
use this form for their program and you think it would benefit
you to try to work through that process of Medicaid eligibility,
I'd be glad to scan that to you, so just drop me an email
and I'll be glad to do that.

Next slide please. Basically, we provide the
resources of a collection specialist because we really
know that it's a good tool and an aid for Medicaid enrollment. Smiles for a Lifetime
is all about providing and promoting overall health. There are, as Donna spoke about,
a lot of organizations across the nation. Some just do sealants,
some do cleanings and sealants, there are just tons of
different combinations of what is offered in oral health. For 16 years our program
has all been about preventive and restorative,
and we have seen, especially in our Allendale
clinic which has been open the longest, we see about
850 children here each year. And in the early years,
for many, many years, we had 600-700 charts that
always had decay in them. After about 8 or 9 years,
we started seeing a real pattern. Now when we get to the end
of the school year, last year we saw 850 kids and
at the end of the year we only saw 35 charts that had decay.

And those were basically found
in the months of April and May, right before school got out. So we see over time what it has
done with the education process, teaching these children
how to brush and floss, encouraging constantly that
education in the school system that all of our centers
are really showing where by providing the restorative,
these kids are now coming back, many come for six month
cleanings and have no decay or just one cavity.

It's really a heartwarming
experience for us to see what we've done for these kids. It really benefits all
the children that you can get on Medicaid to go through
this process. Next slide. So I just appreciate
the opportunity, and I hope I've shared
some great information. Please feel free to drop me
an email if I can help you in any way. >> Gabby Duran
Thank you Georgia. >> Georgia Famuliner
Thank you. >> Gabby Duran
Thank you for sharing the great work that you all do at Smiles
for a Lifetime and offering up those resources for school. Our next speaker is Matt Jacob. Matt is the Communication
and Outreach Director at the Children's Dental
Health Project.

Matt? >> Matt Jacob
Hi everyone, thank you very much. Next slide please. I'm going to try and move
through this quickly so we can get to some of the questions
that many of you may have. I just want to lay out about
five tips that I think will be helpful in using social media. It does take time,
but it doesn't take money.

So it is a really good vehicle
for getting messaging out there, reaching a variety of
stakeholders and people who work with parents
and families. The first tip is to make sure
and work the term "dental" into your messages. Make sure that parents and
families and caregivers do know that kids' dental exams,
cleanings and other services are a basic part
of Medicaid coverage. The second item is
to think about hashtags. Many of you see those,
they pop up occasionally in Facebook,
they are used a lot on Twitter. On both of those social
media platforms, hashtags are a great way
to help other people find you.

So you are probably familiar
with the #Enroll365 hashtag. Consider in addition to
that some other hashtags, and these are just some examples
that can help you bring greater attention
to what you're talking about. Next slide please. I think this is just
a good example of what I'm talking about. Go ahead and show me
the next slide please. So here you see #WomensHealth,
which is a pretty popular hashtag that is used on both
Twitter and Facebook. So people who are interested
in this issue will often just search that hashtag to see,
what is the conversation, what are people saying
about women's health.

I'm not recommending that you
throw that hashtag into your messages all the time,
but working it in when you think it's appropriate every now
and then I think is just a good way to hopefully
draw a broader audience. Next slide please. This is a simple way
to do a search. So if you want to see what
people are talking about, for example #LatinoHealth
if you want to see if coverage, health issues, etc.
are part of the conversation. This is just one example of
a way to get better attuned to what those micro communities on
social media are talking about. Next slide please. I think it's also
helpful to appeal to your audience's curiosity. Having involvement devices
I think can be very helpful. And a quiz is a good idea. It's one example of that. It doesn't have to be
a long thing, it can be three
or four questions. And the best thing
is that it, again, does not have to be
a cost issue. There are several sites
that offer free access to create quizzes. They are incredibly
user friendly, I'm just throwing out
a couple here, Playbuzz, Qzzr, there are probably several
others that I haven't thought of at the moment.

These are not difficult
to create. So I just want to throw
that out there, it is something to keep
in your hip pocket. Next slide please. I think any way we can
put a face on the issue is very helpful. I realize because of
the nature of, you know, we want to respect
privacy, HIPPA, all those things,
we don't want to start taking cameras around and snapping
photos left and right. But even if it's just,
you know, you're doing some volunteer work,
you're reaching out to the community,
you're raising awareness, even just snapping some photos
of you and your volunteers doing their thing,
not necessarily taking photos of people you are trying to enroll. That wouldn't necessarily
be appropriate. But any way you can,
even if it's sharing news stories that have photos
and other images. I think those are just something
to think about as well. Next slide please. And then last but not least,
there are social media events that are going on. The beauty of it is you don't
really need an invitation.

People will probably be pleased
just to know that you are interested and
want to participate. So keep an eye out. You can even do a search on
Twitter for the word "chat" or "storm," those are two examples
of the names that people give these kinds of events. Next slide please. And you will find that
your messages are likely to get re-tweeted by others,
so you will reach a larger audience in that way,
which is very helpful.

There are two main
Twitter events. For example, I referred
to a chat, this is generally
a Q&A format. There is usually an organization
that acts as the moderator and asks each question after
it welcomes different groups to the event. Then it waits for people
to tweet in their answers. A storm is not
a moderated event. It Is generally kind
of a free for all. There is usually a host
organization at the top of the hour that may welcome
everybody and briefly mention what the event is about,
what the theme is. And then at any given time,
different organizations or Twitter account holders can weigh
in and share their messages and voice their concerns or
their positions on things. Sometimes these last
multiple hours, but they are usually
about an hour. Next slide please. Here are a couple events
I want to make sure are on your radar screen
if you have the time. They are both Twitter events.

The first one is next Tuesday,
and it is hosted by Salud Today, a Latino health promotion
organization that is based in San Antonio. This is the time and this
is what is going on, the hashtags that will be used. Next slide please. And then the very following
week, the 22nd, MomsRising is doing a chat as well. Both of these Twitter events
are going to focus on Children's Dental Health Month. So this is just a great
opportunity to remind people about the importance
of coverage, making sure parents are
encouraged to determine whether they are eligible
and learn more, making sure they know
dental care is actually a basic part of Medicaid. So I really encourage you
to get involved in these. MomsRising has more
than 50,000 followers, so when they retweet
your message it is really going to a very broad audience. Next slide please. So if you say to yourself,
gosh, this is all well and good Matt,
but I don't have a lot of time to sit down and write tweets. We have solved that for you.

Feel free to reach
out to me by email, I have a messaging kit
with some sample messages that you could choose from. Also the Think Teeth page has
a really nice resource of some sample social media
messages about the importance of Medicaid and CHIP
that you can use as well. Next slide please. So I hope this was helpful. Feel free to reach out
to me if you have any questions. Thank you. >> Gabby Duran
Thank you Matt for sharing those helpful tips and also
sharing the upcoming oral health Twitter events. And thank you for mentioning
the Think Teeth page. While we're on that,
I'm going to have Laurie Norris now walk us through more
information about the Connecting Kids to Coverage National
Campaign resources. Laurie? >> Laurie Norris
Okay, thanks Gabby. So just a real quick tour
through some of these resources that are available to you on
the insurekidsnow.gov website. You can find these under
the Outreach Tool Library tab or on the Think Teeth page
that Matt just referred to.

So available resources include
things like tip sheets and newsletters and ready-made
article templates, public service announcements,
and various other digital media tools. Here are some more examples
on the next slide. You can, as I said,
in the Outreach Tool Library there are a plethora of social
media materials that will help you get ready to participate
in the stuff Matt was talking about. We have social media content and
graphics that you can share through your social channels and
your eNewsletters and that you can share
with your networks. We do have particular things
that are related to oral health. We've branded those materials
our Think Teeth materials. We have buttons and banners
and flyers to hand out. Just a whole array of things.

So be sure that you go in there,
take a look around, and see what you might be able
to use in your campaign. Next slide. These are,
go back one slide. This is just some specific,
a tear pad on the left, that is useful for providers. We've found that physicians
and pediatricians are particularly fond of this,
so if you are partnering with your medical community at all,
this is a good thing to make them be aware of as well as our
flyer for parents on the right. Parents who have children with
special needs often have a hard time finding a dentist
who can accommodate their child's particular needs. And this is a tip sheet for how
to locate such a dentist. All of these materials
are available for free either by download or to order
from our distribution center. Next slide. So this is something I really
wanted to make you aware of.

If you are in the Connecting
Kids to Care part of your work and you're having difficulty
finding a dentist that participates in your child's
Medicaid or CHIP plan, this is the tool for you. There is a widget which you can
see a picture of here on the screen that you can download and
post and embed directly into your organization's website. There is also a full
interface dentist locator, which if you just google
"find a Medicaid dentist," I just tried that this morning,
it comes up as the third thing on the list. It's a really terrific tool,
you can search by state, by health plan,
by zip code, by city. You can also search
by dentist specialty type, if you need an oral surgeon
or pediatric dentist. You can search
by "accepts new patients." It has a lot of functionality.

So we really recommend that
you take a look at that tool. Back to you Gabby. >> Gabby Duran
Great, thanks so much Laurie. And because we do
have some questions, we're going to sort of run
through these next slides a little quicker than usual. But we do have customizable
materials as an option for our Insure Kids
Now materials. They are available in both
English and Spanish along with a number
of other languages. The process takes
about two weeks.

Next slide please. All of our outreach videos
and previous webinars are also available in the Outreach
Tool Library on the Insure Kids Now website. The outreach videos are short
videos that showcase a variety of outreach and enrollment
promising practices from groups across the country. And please do keep in touch
with us about what's going on with the campaign. You can follow us @IKNGov,
and as Matt was saying you can use some of our hashtags to tag
messaging using them about CHIP and Medicaid coverage,
including #Enroll365, #KidsEnroll, #Medicaid,
#CHIP, and #ThinkTeeth as well. You can also sign up
for our campaign eNewsletters here and email us at
connectingkids@cms.hhs.gov if you want to share
any success stories. Now we're going to leave
some time for questions. We've been monitoring them
throughout the webinar and want to take this opportunity
to address some of these. If you haven't asked
a question yet, please type the question in
the chat box now and we will get back to you even
if we don't address your questions here
on the webinar.

One question that we have here
is that one challenge that one of the attendees has seen
and experienced with families that they serve is
a lack of access to orthodontists
that accept CHIP. Does CHIP cover
orthodontic treatment? >> Laurie Norris
This is Laurie, I can take that one. In almost every
state, yes. I think there might be one or
two states that are holdouts. So probably in your state
it is a covered benefit. But it is not covered
for cosmetic purposes. It is only covered for
medically necessary purposes.

And every state has its own
criteria for what constitutes medically necessary orthodontia. But what I would suggest is that
this caller or the parent could go on the Find a Dentist tool
and look in your town and in the child's plan and find an
orthodontist and get an opinion. Or if the child already
has a general dentist or a pediatric dentist,
that person could also help guesstimate whether the child
should see an orthodontist to see whether a request should be
submitted to see if the child could get orthodontia
through Medicaid or CHIP. >> Gabby Duran
Great, thanks so much Laurie. Georgia, we have
a question for you. We had an attendee ask
how families pay for the Smiles program. Do they charge the child's
current insurance? >> Georgia Famuliner
Any child that has Medicaid we take their Medicaid number
and that's the way we get paid. If a child has
private insurance, we accept whatever
the insurance pays us.

And then of course children that
don't have insurance or Medicaid we see those children
at no cost to the parent. That way we ensure that any
child that does not have a dentist in the towns we're in
that would like to see a dentist gets to come to Smiles if
their parent signs a consent. Does that answer that question? >> Gabby Duran
That's great, yes, thank you Georgia. We have one more question
about orthodontics. We actually had someone
ask about braces. >> Laurie Norris
Same answer. And I just played around
on the Insure Kids Now Dentist Locator tool,
and there are definitely CHIP participating orthodontists
in Pennsylvania.

So I will infer from that
that Pennsylvania CHIP covers orthodontia when
medically necessary. So you should be able to find
somebody if you take a look in the Dentist Locator tool. >> Gabby Duran
Great, thank you so much Laurie and Georgia for answering
those questions today. We will be starting to wrap up. Again, I want to thank you
for joining the webinar today, and thank you all of our
speakers for all of the wonderful content.

As I mentioned before,
the campaign resources are available for download
on insurekidsnow.gov. A recording of this webinar
will be available on the website in about two weeks. If you've missed
any past webinars, please check out the webinar
archive on insurekidsnow.gov. Again, thank you all for joining
today and we wish you luck in your outreach and enrollment
for this month and the rest of the year as well. Thank you..

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