Miles for Smiles Mobile Dental Unit

Description

Seven counties in southwest Missouri found that children living in the region lacked adequate dental care. The children at most risk were those either covered by Medicaid or in families without health insurance. In fact, at the time of the initial Federal Office of Rural Health Policy (FORHP) grant, no dentists in the seven-county region were accepting Medicaid or non-paying patients, even if those patients were children. The mission of the Miles of Smiles project was to create a mobile dental unit to provide quality, onsite dental care to low-income children.

Miles for Smiles, originally begun in 1999 as a mobile dental unit with one chair, is now owned and operated by Ozarks Community Health Center (OCHC). It is the result of collaborative efforts of a 40-member task force that included representatives from local human service agencies, healthcare organizations, businesses, the education system, local media, government agencies, and private citizens. Through this collaboration, the organizations worked in tandem to ensure a comprehensive array of dental services was available to the area's children.

The project was originally designed to serve kindergarten through eighth-graders without adequate health insurance or for those covered by MC+, a state-sponsored insurance program for low-income families. Because of a large demand for dental services for children ages 3 to 5 years and through the high school years, the project further expanded its scope.

The mobile clinic travels throughout the target region to approximately 30 schools in 7 counties during the school year. During summer months, two county health departments are served. For the school clinics, parents sign permission slips for their children and school nurses schedule the appointments during school hours.

Although Miles for Smiles accepts all patients with all kinds of payment methods, 90-95% of its clients have Medicaid. Since the purchase of Miles of Smiles by OCHC, the program began to serve uninsured patients using a sliding fee scale. Care was also provided to privately insured patients. OCHC, a Federally Qualified Health Center (FQHC) that was established in 2012, offers medical, dental, and behavioral health services with offices located in Hermitage, Bolivar, and Urbana.

Original funding for the Miles for Smiles unit was a 2000-2003 Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach grant. The Missouri Foundation for Health (MFFH) also provided two grants in the early 2000s: one for $150,000 and the other a 3-year, $1.3 million-dollar grant. These grants covered the project's operating expenses for three years and allowed project coordinators to purchase a new mobile clinic, hire new staff, expand services to five more counties, and implement a new oral health prevention educational program.

Services offered

• General dental services on the mobile unit for children ages 3-18
• Dental services for all ages in two office locations
• Fully equipped mobile dental clinic that provides onsite dental care
• Dental screenings and oral examinations
• Cleanings, X-rays, fillings, crowns, root canals, sealants, endodontics, dentures, and extractions
• Oral health education
• Adult dental services
• Acceptance of Medicaid, private insurance, self-pay, and sliding fee scale

Results

In 2013, 3,559 children were seen by Miles for Smiles, with a total of $1,045,891.91 in services provided. In 2016, 1,328 mobile visits were completed.

The program has had continued success: In 2017, nearly 3,500 visits and charges for over $1 million and in 2018, around 2,200 visits with charges totaling over $550,000.

Challenges

• Dental staff recruitment
• Reimbursement and funding issues

Replication

Rural children often lack access to dental care, so the Miles for Smiles model could be useful in many rural communities. In fact, staff members involved in this project have worked with other local communities as well as programs in other states to provide planning and implementation assistance. Local health departments and state welfare agencies are well-positioned to offer such a program to Medicaid-eligible and low-income families.

Dental staff recruitment is an ongoing challenge.

On January 1, 2016, Citizens Memorial Healthcare sold the program to Ozarks Community Health Center in Hermitage, Missouri. Since FQHC reimbursement is competitive with traditional dental offices, the original owners felt that the program would be sustained under OCHC's care.

Contact Information

Amanda Dahl, Dental Clinic Manager
Miles for Smiles
417.328.6334
amanda.dahl@ozarkschc.com