If you need to see a doctor, you've got plenty of health professionals who can help, from certified nursing assistants all the way to hyper-specialized doctors. This gives patients more options when it comes to their health care. But in the field of dentistry, there are fewer options.

Senate Bill 541, introduced last year by Sen. Mike Shirkey, R-Clarklake, would create another avenue for care by adding a mid-level dental professional, much like a physician’s assistant.

The bill is currently under review in the House. If it passes, it would create a new licensed professional called a dental therapist who would be able to perform small procedures such as filling cavities.

The bill contains a requirement that would mandate dental therapists in private dental offices  ensure half their patients are Medicaid recipients. Public health care providers are on board with this provision.

The Mackinac Center for Public Policy suggests that the implementation of dental therapists would ensure Medicaid recipients receive the care they need while reducing Medicaid costs. Many Medicaid patients do not have access to dental care and small issues can grow into dangerous abscesses and infections that lead to expensive emergency room visits, which Medicaid still has to pay.

The Michigan Dental Association opposes this legislation, citing low Medicaid insurance reimbursements as the cause of underserved populations and has expressed concerns about dental therapists working without dentist supervision.

“The focus should be on real solutions, such as better utilizing Michigan’s existing workforce, creating incentives for providers to work in underserved areas, and making sure that all Michigan residents have access to the same quality care,” says MDA President Debra Peters.

Broader Medicaid reform is likely necessary, but in the meantime the creation of a mid-level provider would offer a less-costly professional who could make lower Medicaid payments work for dental practices -- consequently expanding access to dental care.

In addition, the Legislature would limit the number of procedures a dental therapist may perform, and the supervising dentist would have leeway as well. If dentists are not yet comfortable with the skill set of a dental therapist, they could forbid them from performing certain procedures.

Resistance to incorporating a mid-level care provider is not new. Years ago, a similar war was waged over physicians' assistants and nurse practitioners, but now it is hard to imagine operating without these health care workers.

“It is important to make sure that state health care policy is not a barrier to health care providers finding solutions for their communities,” says Ryan Grinnell-Ackerman, government affairs manager at the Michigan Primary Care Association.

Minnesota has used dental therapists since 2009. After creating a set of accreditation standards, the state got two schools to form curriculum and now there are 86 dental therapists working to great effect in Minnesota. Maine and Vermont have also authorized dental therapists, and several other states are considering doing so. 

Adding a mid-level worker to the dental profession is a sensible measure to ensure all patients' needs are being met. 



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