Enrollment, Navigation, and Referral Model
The enrollment, navigation, and referral model is designed to expand access to oral health services through
whatever program an individual may be eligible. In rural communities, this model is often a component of a school-based model, dental clinic model, or dental home model.
Dental coverage for children has expanded over the years through the Children's Health Insurance Program,
improvements in state Medicaid programs, pediatric dentistry training, and dental management organizations.
However, some rural communities do not have adequate access to dentists who accept Medicaid payments for adults.
Rural oral health programs can work to expand access to dental coverage through community-based strategies.
Some programs provide insurance counseling and enrollment assistance. For example, one rural community works
with Medicaid outreach workers to enroll eligible individuals into Medicaid. The Medicaid outreach worker also
coordinates with local offices to secure applications and renewal forms ahead of dental visits.
Some programs also offer referral services. Another rural oral health program, for example, works with the
county health department to refer individuals to a dental home. This program has an arrangement with local
dentists to provide dental services at a reduced cost. Programs may also provide information and referrals to
help families to access other social services that are available in the community as well as transportation
Examples of Rural Oral Health Enrollment, Navigation, and Referral Programs
The Access to Baby and Child Dentistry program works to increase the
number of Medicaid-enrolled babies, toddlers and preschoolers who receive dental care in Washington state. In
2018, more than half of children from families with low incomes in the state had received care — an increase
from 20% in the early 2000s.
For additional examples of this model, see the following programs in the Rural Health Models and Innovations
While dental coverage is mandatory for children enrolled in Medicaid, dental benefits are optional among adults.
Therefore, dental coverage may vary from state to state. For example, some states may only provide emergency
coverage like tooth extraction as part of the dental benefit package. Medicaid enrollees often find it difficult
to find providers who accept Medicaid — particularly in rural communities where there is already a
Enrollment, navigation, and referral models require strong partnerships in the community where patients can be
referred for dental or other services. Potential partners may include colleges, health and social service
agencies, schools, dental societies, churches, Area
Health Education Centers, and legal services organizations.
Resources to Learn More
Oral Health Care Delivery in Medicaid and CHIP: A Toolkit for States
Offers states a mechanism to improve oral healthcare and meet the goals of the CMS Oral Health Initiative.
Provides a six-step continuous quality improvement (QI) model helping states use and analyze data to identify
gaps and variations in their Medicaid and CHIP oral healthcare programs.
Organization(s): Centers for Medicare & Medicaid Services (CMS), Mathematica Policy Research
Medicaid Adult Dental Benefits: An
Overview of the challenges in accessing and utilizing oral healthcare for low-income adults. Describes the
potential of Medicaid expansion to improve oral health access and services among adult populations who need
Organization(s): Center for Health Care Strategies, Inc. (CHCS)
Medicaid and Rural Health
An overview of the Medicaid program, policies, and services in rural America. Describes the socioeconomic
factors, insurance coverage, health status of rural residents, and provider availability relevant to rural
Organization(s): Medicaid and CHIP Payment and Access Commission (MACPAC)
Rural Healthy People 2020 Volume 2: Rural
An overview of oral health issues in the rural U.S. highlighting community models that are known to work in
Author(s): Kash, R.A., Hutchinson, L., Kaul, S., Appiah, P., & Challa, S.
Organization(s): Texas A&M Health Science Center, Southwest Rural Health Research Center