About 12 years ago, a nonprofit focused on substance abuse prevention in Lyon County, Nevada, expanded its services to dental care.
Leaders of the Healthy Communities Coalition were shocked when two of their food pantry volunteers used pliers to pull each other’s abscessed teeth. The volunteers saw no other option to relieve their excruciating pain in the small town 40 miles southeast of Reno because of a shortage of dental care providers.
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Wendy Madsen, the coalition’s executive director, said that strenuous work inspired her organization to use mobile clinics to offer health and dental services in rural communities where it’s hard to support brick-and-mortar offices. There are not enough patients for
The coalition now sends a van equipped with dental equipment to county schools to treat hundreds of students per stop a few times each year. They also host programs for adults in the area. The response has been overwhelming.
“Dental is the hot ticket,” Madsen said. “Everybody wants a dentist. The availability of those services tends to be the first to go out at those big mobile events.”
The Coalition’s mobile programs reflect efforts to deliver services to patients facing gaps in the healthcare system across the country, especially in rural areas.
Rural residents face a more significant shortage of healthcare providers, including dentists, than their counterparts in large cities. Since the start of the pandemic, mobile clinics have extended access to a range of services in remote locations with sparse populations.
A recently passed law that makes it easier for rural communities to pay for new mobile clinics could expand this trend. In the past, clinics serving low-income rural residents could not spend federal grant money, called new access point grants, on mobile services in communities where they did not already have facilities.
Then last fall, Congress passed the censor-sponsored Mobile Health Care Act. Jackie Rosen (D-Nev.) and Susan Collins (R-Maine), which gives federally qualified health centers — health clinics serving medically underserved areas — more flexibility. Use federal funding to build and operate mobile units.
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According to the National Association of Community Health Centers, there has been an expansion in the number of mobile clinics on the street since 2019. Many were used for COVID-19 testing and vaccination. And health and community organizations have begun using mobile units to provide primary care, behavioral health and reproductive services to patients who are far away. The new funding route could soon put even more mobile health vans on the road.
For now, the legislation is dependent on funding from Congress, and experts estimate it will be at least a year before health centers can use the grant money.
More than 2,000 health center advocates went to Washington, D.C., in early March to ask lawmakers to support multiyear grant funding, said Amy Simmons Farber, associate vice president of media relations for the National Association of Community Health Centers.
Once funded, the regulatory change would allow health centers to partner with independent organizations, such as Madsen’s Health Community Coalition in Nevada, to expand services to underserved areas. Because the alliance is not a federally qualified health center, it relies on a mix of other federal and state grants.
About 1,400 federally qualified health centers receive federal funding to provide comprehensive health services in under-served areas across the country. Steve Messinger, policy director for the Nevada Primary Care Association, said the previous requirement that health centers establish brick-and-mortar clinics before expanding to mobile clinics kept many people from applying. This was cumbersome and expensive for health centers.
But in rural areas with small populations, well served by mobile clinics, setting up a building with the first full-time provider would not make sense, he said. It can eat up a federally qualified health center’s budget.
While the health center advocates lobby Congress for base funding, the Healthy Communities Coalition is moving forward with three dental programs this year funded by a grant from the Health Resources and Services Administration, part of the Department of Health and Human Services.
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Madson said at the first medical outreach event the coalition held in 2012 in Lyon County, where 61,400 residents are spread over more than 2,000 square miles, more than 200 people showed up to receive free care and 150 teeth were pulled. Since then, the organization has hosted several events over the year – except in 2020, when the pandemic halted work.
Many dental programs are school-centered and provide services such as screenings, X-rays, sealing, varnishes, and cleanings to children. But an unmet need for care also exists among adults in the region, Madson said, because Medicare and Nevada’s Medicaid don’t include comprehensive dental coverage for adults. Funding those events is difficult, she said.
Silver Springs, at least one of five Lyon County communities, does not have a dentist. There are a total of 10 dentists in Fernley and Dayton, the communities have a combined population of 38,600 people, but only two of those practices accept Medicaid, which provides limited dental services for low-income people and adults under the age of 21. It covers
Traci Rothman, who manages the coalition’s food pantry, said the dental outreach events made a difference for her 29-year-old son, who moved to Silver Springs last year. He went to two mobile clinics to get free care, which Rothman said was a huge relief because he is uninsured and badly in need of dental care.
“Otherwise, you’re going to have someone say you’re paying cash,” she said. “At times I honestly cannot pay; It is out of reach for some, or most people… in rural areas.
Madsen said the coalition stepped in to help a young student in dire need of a root canal. The coalition is helping the girl’s family apply for Medicaid or Nevada Check Up, the state Children’s Health Insurance program, and is paying $1,600 to cover the service with federal grant money. Another student had to be referred to several specialists before having her decayed baby teeth surgically removed and receiving restorative treatment for adult teeth that had begun to decay.
“Her mom was so grateful, she was in tears,” Madson said. “She told me her daughter woke up without any pain for the first time in years.”
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Madsen said her organization has enough grant money for three events through May, but she hopes the Mobile Health Care Act will help expand services. In addition to dental care, the group provides primary care mobile clinics for immigrant workers in Yerington, a small town in an agricultural area about 70 miles southeast of Reno.
Sarah Rich, CEO of Choptank Community Health in Maryland, said she shares Madson’s hope.
Choptank serves five counties in Maryland, including small towns between the Chesapeake Bay and the Delmarva Peninsula. In the midst of the pandemic, the health organization struck an unlikely partnership with a car dealership and used federal COVID relief funds to buy Ford Transit cargo vans for mobile clinics.
Choptank used its new van to provide vaccines, but has since begun using it to provide primary care to migrant workers and dental services to children in 36 schools. The mobile clinics have been so successful that the health center is working on purchasing more vans to expand its services.
Rich said mobile clinics are “breaking down the barriers that a lot of us have been working at for a long time.”
New services Choptank plans to offer include behavioral health, substance use disorder prevention and treatment, and skin screenings for people working on Maryland’s waterfront.
“Resilience has been a theme over the past few years,” Rich said. “I think this Mobile Health Care Act will help us do even more in the future.”
Kaiser Health News is a national health policy news service. This is Henry J. is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.