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Rural Health Information Hub

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 assistance.

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.

Implementation Considerations

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 workforce shortage.

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

Improving 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
Date: 6/2014

Medicaid Adult Dental Benefits: An Overview
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 them.
Organization(s): Center for Health Care Strategies, Inc. (CHCS)
Date: 9/2019

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 healthcare.
Organization(s): Medicaid and CHIP Payment and Access Commission (MACPAC)
Date: 4/2021

Rural Healthy People 2020 Volume 2: Rural Oral Health
An overview of oral health issues in the rural U.S. highlighting community models that are known to work in rural areas.
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
Date: 2015