Low income residents of the Central Valley face limited access to oral health care due to barriers, including a shortage of dental health professionals, a maldistribution of services, and a lack of providers willing to accept uninsured or publicly insured patients. Federally Qualified Health Centers (FQHCs) ease access barriers by providing oral care to underserved populations. In an effort to respond to regional concerns regarding the shortage of oral health professionals, a survey was conducted to evaluate the impact of these shortages in the Central Valley.

This report presents findings from an oral health survey of FQHCs that offer dental services onsite. The 12 FQHCs surveyed were members of the Central Valley Health Network. Survey participants included chief dental officers, dental supervisors, dental services managers, directors of operations, and an executive assistant. The survey included 34 qualitative and quantitative questions that described clinic operations, staffing, patient visits, referrals, and future plans to expand services.

Findings from the survey demonstrate that FQHCs face a common set of challenges in providing access to oral health care. One of the challenges of the FQHCs is the limited capacity to provide care. Only half of the FQHCs reported having enough operatories to provide services to patients. In addition, more than half of the FQHCs stated that the number of operatories was a barrier to providing care. Of the FQHCs planning to expand dental services, nearly all reported that capital for facilities will be a factor in their future expansion efforts.

The FQHCs also reported that patients have difficulty accessing oral health specialty care due to the limited providers who accept uninsured or Medi¬Cal patients, the expensive costs of specialty care, and traveling long distances to obtain care. All of the FQHCs stated that financial difficulty of patients was a barrier to receiving care. Other barriers to accessing care were lack of insurance, transportation, childcare, and social services support. All FQHCs also reported experiencing barriers to providing services. The main barriers include a lack of specialists, insufficient operatories, and low reimbursement rates.

The survey respondents were asked to identify possible solutions to access concerns resulting from dental professional and support staff shortages. The most common solution reported was the expansion of loan repayment programs for dentists and support staff. Others reported incentives and the use of different recruiting strategies as solutions. The FQHCs also suggested higher base pay salaries for dentists.

Oral health policy recommendations are presented based on findings from this study as well as consulting with FQHC leadership. The proposed policy recommendations based on the findings of the survey include: 1) The protection, expansion, and enhancement of government funded oral health care programs for underserved and uninsured populations; 2) Increasing reimbursement rates for oral health care services at FQHCs; and 3) Establishing a permanent and continuing revenue source to fund the state’s loan repayment program for providers willing to serve in medically underserved areas. The policy recommendations based on FQHCs long¬term capacity to provide oral health care include: 1) Establishing a select and/or sub¬committee in the state legislature that focuses specifically on health care issues in the Central Valley, including oral health; 2) Extending hours of intermittent clinics, which may also contain dental operatories, from 20 operational hours to 40; 3) Having an administrative change in FQHCs being treated as non¬institutional providers; 4) Monitor and pursue the implementation of SB 564, which requires the State Department of Public Health to extend funds appropriated for implementation of the Public School Health Center Support Program; and 5) Licensing reform for community health centers in order to streamline the licensing process for community health centers.

To access the Central Valley Oral Health Study, click here