Volume 4, No. 6, August 2015

New Hampshire State Capitol

IN THIS ISSUE:

• Colorado Governor Weighs in on • Maine Secretary of State Accepts Dental Hygiene Therapy Program Rules • Oregon Governor Signs Bill Requiring Dental Screenings for Students Seven and Younger • Kentucky Governor Announces Loan Forgiveness Program for • Arkansas State Dental Association Votes to Work with UAMS to Study the Feasibility of a Public College of • Oregon Becomes Second State to Offer Students Free Tuition at Community Colleges • Alaska and Utah Governors Announce Plans to Expand Medicaid • MACPAC Issues Summer 2015 Report to Congress and Discusses Adult Dental Benefits • Twenty-eight States Join the State Authorization Reciprocity Agreement as Federal Rules Take Effect • The National Governors Association Announces New Executive Committee Leadership • Alabama Supreme Court Upholds Law Restricting Non-Dentists from Offering • U.S. Court of Appeals for the Second Circuit Rules on Tooth Whitening by Non-Dentists • Hawaii Becomes First State to Raise the Smoking Age to 21 • Ten States Selected by the National Governors Association to Participate in a Policy Academy • State Policy Update • State Regulatory Update • Reports of Interest • ADEA Advocacy Website: Helping You Stay Abreast of State and Federal Legislation and Policy • ADEA AGR Twitter Account • ADEA/Sunstar Americas, Inc./Harry W. Bruce, Jr. Legislative Fellowship • ADEA/Sunstar Americas, Inc./Jack Bresch Student Legislative Internship

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Colorado Governor Weighs in on Water Fluoridation

On July 29, Gov. John Hickenlooper (D-CO) and Dr. Larry Wolk, executive director and chief medical officer at the Colorado Department of and Environment, issued a joint statement in support of water fluoridation in the state. The statement was issued in anticipation of a Denver Water Board informational meeting, held that same day, in which community water fluoridation was being discussed and anti- activists were requesting that fluoride be removed from the water supply. The following joint statement was issued by Gov. Hickenlooper and Dr. Larry Wolk:

“The Governor’s Office and Department of Public Health and Environment (CDPHE) recommend all Colorado communities fluoridate their public water supplies. More than 70 years of research has proven that community water fluoridation is a safe, effective and inexpensive method of improving the oral health of all Coloradans. Increasing the number of communities that voluntarily fluoridate their residents’ water can make a significant contribution to Colorado’s commitment to becoming the healthiest state in the nation.

Dental disease places a significant burden on our state. Students miss school, workers are less productive and many Coloradans suffer needlessly from preventable dental disease. Colorado communities that fluoridate their water supplies can reduce their resident’s cavities by as much as 40 percent and save them each an average of $61 per year in dental costs for an investment of just $1 to $2 per person per year … CDPHE recommends communities fluoridate their public water supplies to 0.7 milligrams per liter."

According to the Denver Water Board’s website, Denver Water only supplements fluoride levels at its treatment plants when the natural concentration falls below the levels recommended by state and national health organizations.

Denver Water Board members will weigh all of the information presented during the informational meeting (both pros and cons for fluoridation) and are expected to take action on the fluoride policy at their Aug. 26 board meeting.

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Maine Secretary of State Accepts Dental Hygiene Therapy Program Rules

On June 29, the Maine Secretary of State’s Office accepted the Maine Board of Dental Examiners (Board) filing of its adopted rule—“Requirements for Establishing a Board Approved Dental Hygiene Therapy Program.” The rule became effective on June 29.

The rule establishes the minimum requirements for dental hygiene therapy programs approved by the Board as a pathway toward licensure until such time as programs are accredited by the Commission on Dental Accreditation (CODA) or a successor organization.

Under the adopted rule, a dental hygiene therapy educational program not accredited by CODA based on the unavailability of a CODA accreditation process may receive approval from the Board if:

1. The educational institution is accredited by an agency recognized by the U.S. Department of Education; 2. The educational institution meets all requirements of the Maine Department of Education or other state department of education if located in another state; 3. The educational institution has a CODA-accredited program in either dental hygiene or predoctoral dental program; 4. The educational institution submits a written request and forms prescribed by the Board; and 5. The educational institution and program meet all of the requirements of this chapter.

The 24-page rule also outlines requirements that educational institutions must meet to obtain approval from the Board, such as:

• Institutional effectiveness. • Curriculum, including minimum competencies. • Faculty and staff. • Student admissions. • Facilities, including clinical and radiography facilities. • Health, safety, and patient care.

Oregon Governor Signs Bill Requiring Dental Screenings for Students Seven and Younger

On June 25, Gov. Kate Brown (D-OR) signed H.B. 2972 into law. Under the new law, Oregon children who are starting public school and are seven years old or younger will be required to have dental screenings, or show proof they have had one.

Specifically, starting with the 2016–17 school year, new students will have to submit certification that they have received a screening within the previous 12 months from a licensed or , or from a qualified health care practitioner who is a school employee trained to spot dental problems. The certification must be submitted within 120 days of the student’s first day, for the student to remain enrolled. In certain circumstances, a student may be exempt from this requirement.

Rep. Cedric Hayden (R-OR), a dentist who sponsored the bill, said it will have little impact on children who already receive regular dental care. “This is designed to capture children that don’t have that opportunity,” he said.

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The new law also requires school districts to report to the state annually on the percentage of their students who did not submit dental certifications.

Kentucky Governor Announces Loan Forgiveness Program for Dentists

On July 20, Gov. Steve Beshear (D-KY) announced the creation of a new loan forgiveness program supported by $500,000 in state funds available to dental students who commit to practice in the region. The University of Kentucky College of Dentistry and the University of Louisville School of Dentistry will administer the program, providing two to five awardees $100,000 each for a two-year commitment. Specifically, the Kentucky Department for Public Health (DPH) is funding the program, and the universities will offer awardees a $50,000 up front payment and $50,000 at the end of the first two-year award cycle.

“Reversing the oral health issues facing eastern Kentucky has been a major goal of mine throughout my administration,” Gov. Beshear said.1 “The vast majority of both childhood and adult dental problems could be avoided through routine dental care and other preventive efforts. This unique program and partnership will truly expand dental hygiene and help counter oral disease as a major health risk for our people.”

According to the Kentucky DPH, Kentucky ranks 41st in annual dental visits, 45th in the percentage of children with untreated dental decay and 47th in the percentage of adults 65 and older missing six or more teeth.

Arkansas State Dental Association Votes to Work with UAMS to Study the Feasibility of a Public College of Dentistry

In June, the leadership of the Arkansas State Dental Association (ASDA) voted to concur with the development of a formal plan for a public college of dentistry through the University of Arkansas system, and to assist the system in creating an external advisory committee to participate in the planning process. Acting on a letter from Dr. Dan Rahn, Chancellor of the University of Arkansas for Medical Sciences (UAMS), the ASDA Executive Council voted unanimously to assist UAMS as it begins the formal process of developing a plan.

“The projected need for future dentists in Arkansas and the skyrocketing costs and debt that Arkansas students are experiencing as they pursue their dental education out of state both create a strong case for Arkansas having its own college of dentistry,” Rahn wrote. “It is entirely consistent with UAMS’s mission and scope that we take the lead in the planning process.”

University of Arkansas System President Dr. Don Bobbitt made the presentation to ASDA, stating that serious consideration of a will require both a significant donation from private sources and the full support of the Arkansas legislature.

1 As part of his statewide health initiative, kyhealthnow, Gov. Beshear identified oral health as one of the seven target areas for improvement. Specifically, the program aims to reduce the percentage of children with untreated dental decay by 25% and increase adult dental visits by 10% by the year 2019.

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Oregon Becomes Second State to Offer Students Free Tuition at Community Colleges

On July 17, Gov. Kate Brown signed S.B. 81 into law, making Oregon the second state in the nation to offer certain students free community college.2

“Oregonians can now afford to dream big,” Gov. Brown said. “[We flung] wide open the doors of opportunity by expanding access to post-secondary education, the precursor to a better life.”

The new law, titled the Oregon Promise, provides a $10 million appropriation targeted toward tuition payments for students who are recent Oregon high school graduates attending and pursuing a certificate or degree at one of Oregon’s 17 community colleges. According to the Commission on Dental Accreditation (CODA) website, there are 10 community colleges in Oregon approved to offer dental assisting and dental hygiene programs.

The law funds grants at a minimum of $1,000 for each community college student awarded, to be administered by the Office of Student Access and Completion (OSAC) under the Oregon Higher Education Coordinating Commission (HECC). Tuition grants will begin for students beginning college in the 2016–17 academic year and the maximum grant amount awarded will cover the actual cost of full-time full-year community college tuition. According to the Governor’s Office, approximately 4,000–6,000 students are expected to be served in the first year of the program.

Alaska and Utah Governors Announce Plans to Expand Medicaid

Alaska

On July 16, Gov. Bill Walker (I-AK) sent a letter to the Legislative Budget and Audit Committee (LBA Committee) giving members the required 45-day notice of his intention to accept additional federal and Mental Health Trust Fund Authority money to expand Medicaid in Alaska.

According to the governor’s press release on the matter, “Governors and legislatures in 29 states plus the District of Columbia have already made the decision to accept Medicaid expansion. Ten Republican governors have approved Medicaid expansion. Republican legislatures in five states have approved Medicaid expansion.”

Gov. Walker first included Medicaid expansion funds in his FY16 operating budget; however, the legislature later removed the funding from his budget.

“Expanding Medicaid would bring $146 million to the state in its first year and provide health care to more than 20,000 working Alaskans …. Every day that we fail to act, Alaska loses out on $400,000,” Governor Walker said. “With a nearly $3 billion budget deficit, it would be foolish for us to pass up that kind of boost to Alaska’s economy.”

Utah

On July 17, Utah State leaders announced that they found consensus around a conceptual framework for Medicaid Expansion.

2 Tennessee was the first state to offer a free community college program.

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The group of six state leaders—Gov. Gary Herbert (R-Utah), who recently became Chair of the National Governors Association; Lt. Gov. Spencer Cox (R-Utah); Senate President Wayne Niederhauser (R-Utah); House Speaker Greg Hughes (R-Utah); House Majority Leader James Dunnigan (R-Utah); and Sen. Brian Shiozawa, M.D. (R-Utah)—have been meeting since the close of the 2015 General Legislative Session on this issue. The key principles they are addressing include coverage for those most in need, data accuracy regarding assumptions and projections, sustainability and protecting other critical areas of the state budget.

The skeleton framework of the proposal provides coverage for a population up to 133% of the federal poverty level, utilizing the greatest return of Utah taxpayer dollars through the Affordable Care Act. It protects the State from cost overruns through a formulaic funding model allowing providers and benefactors of Medicaid dollars to pay their share, and is sustainable for many years to follow.

Speaker of the House Greg Hughes said, “It is important that we develop a solution that is in the best interest of all Utahns. If we can provide health coverage for those most in need while protecting other critical areas of our state budget, like public education, I believe we will have a model for other states to follow.” The group will meet with stakeholders and policymakers to develop a formal draft. Once a formal draft is produced, the group will identify specific dates for public hearings through legislative committees and a special legislative session.

MACPAC Issues Summer 2015 Report to Congress and Discusses Adult Dental Benefits

In its June 2015 Report to Congress (see PDF page 23), the Medicaid and Children’s Health Insurance Program (CHIP) Payment Access Commission (MACPAC) reviewed, in part, access to dental care for adults covered by Medicaid. While state Medicaid programs must cover dental benefits for children and youth under age 21, providing adult dental coverage is optional for states, and these services are often cut during times of fiscal austerity. States that cover adult dental services under Medicaid can define the amount, duration and scope of the services covered. MACPAC’s analysis shows that state Medicaid programs vary considerably in the dental services they offer adults, and that access to regular dental care is challenging in many areas of the country.

Specifically, the report states that as of February 2015:

• 19 states provided emergency-only adult dental benefits for non-pregnant, non-disabled adults. • 28 states covered preventive services. • 26 states covered restorative services. • 19 states covered periodontal services. • 26 states covered dentures. • 25 states covered oral surgery. • 2 states covered orthodontia. • 9 states placed an annual dollar limit on covered dental services. According to the MACPAC report, between 2003 and 2012, 32 adult dental benefit changes were made among 20 states, with 10 states making more than one change—14 of these changes decreased dental benefits, and 18 increased dental benefits

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To learn what adult dental services under Medicaid are provided in your state, view Table 2-2 on PDF page 29 of the report.

Twenty-eight States Join the State Authorization Reciprocity Agreement as Federal Rules Take Effect

Thus far, 28 states have joined the State Authorization Reciprocity Agreements (SARA) initiative. On July 31, Illinois was approved by the Midwestern Higher Education Compact (MHEC) to join the Midwestern State Authorization Reciprocity Agreement (M-SARA); on June 1, Iowa was approved by MHEC. To date, Illinois is the largest state to join SARA. Additionally, on June 29, Tennessee, Arkansas and Oklahoma were approved by the Southern Regional Education Board (SREB) to join the Southern State Authorization Reciprocity Agreement (S-SARA).

Those states join 23 others (Alaska, Arizona, Colorado, Idaho, Indiana, Kansas, Louisiana, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Ohio, Oregon, South Dakota, Vermont, Virginia, Washington, Wyoming and West Virginia) as members of SARA. SARA is a nationwide initiative of states that aims to make distance education courses more accessible to students across state lines and to make it easier for states to regulate and institutions to participate in interstate distance education.3

The federal requirements for state authorization and student complaints became effective on July 1. However, the department has not resumed the negotiated rulemaking process for the distance education piece.

The National Governors Association Announces New Executive Committee Leadership

During the 2015 Summer Meeting of the National Governors Association (NGA), the association announced the new members of the executive committee leadership.

The new NGA Chair Gov. Gary Herbert (R-UT) and Vice Chair Gov. Terry McAuliffe (D-VA) will lead the nine-member Executive Committee. The other Executive Committee members include:

• Gov. John Hickenlooper (D-CO). • Gov. Dan Malloy (D-CT). • Gov. Terry Branstad (R-IA). • Gov. Mark Dayton (D-MN). • Gov. Brian Sandoval (R-NV). • Gov. Pat McCrory (R-NC). • Gov. Peter Shumlin (D-VT).

As Vice Chair of NGA, Gov. McAuliffe also serves as Chair of the NGA Center for Best Practices Board. The NGA Center for Best Practices works to develop innovative solutions for public policy challenges facing the states in such areas as education, health, workforce, etc.

3 The SARA agreements are overseen by the National Council for State Authorization Reciprocity Agreements (NC-SARA) and are being implemented by the four regional higher education interstate compacts. Once a state joins SARA, accredited degree-granting institutions in the state that offer distance education courses can seek approval from their state to participate in SARA. When approved, these institutions will be able to operate in other participating SARA states without seeking independent authorization from those states. Participating in SARA is entirely voluntary for institutions, as it is for states.

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In addition, Gov. Jay Inslee (D-WA) will lead the Education and Workforce Committee, and Gov. Robert Bentley (R-AL) will serve as Vice Chair. Gov. Charlie Baker (R-MA) will be Chair of the Health and Human Services Committee, and Gov. Maggie Hassan (D-NH) will serve as Vice Chair. For a complete list of members of each committee click here.

Alabama Supreme Court Upholds Law Restricting Non-Dentists from Offering Tooth Whitening

Keith Westphal and Joyce Osborn Wilson, neither of whom had licenses to practice dentistry, brought suit against the Alabama Board of Dental Examiners (Board) challenging an Alabama statute requiring individuals to have a license to practice dentistry in order to provide tooth- whitening services to the public on the ground that it denied them due process under the Alabama constitution.4 On June 5, 2015, the Supreme Court of Alabama (Court) published its opinion and rejected the plaintiffs’ constitutional challenge to the statute.

Background In 2011, the Alabama Legislature amended the state’s Dental Practice Act to expressly define tooth- whitening services as part of the practice of dentistry. In 2013, Keith Westphal and Joyce Osborn Wilson filed suit against the Board challenging the statute by alleging, among other things, that the statute prohibiting non-dentists from offering tooth-whitening services violated the Alabama constitution and was anti-competitive.

In October 2014, a Jefferson Circuit Court judge validated the statute and ruled that the sale of tooth-whitening products and services constituted the practice of dentistry as defined by the state’s Dental Practice Act, and the law’s restriction on tooth-whitening was “substantially related to public health and welfare.”

Alabama Supreme Court Opinion The question presented to the Court was whether, by extending dentistry’s occupational-licensing regime to include tooth-whitening services, the plaintiffs were denied due process. Under Alabama case law, “the right to due process under the state constitution is violated when a statute, regulation or ordinance imposes unnecessary and unreasonable restraints upon the pursuit of useful activities.”

The Court found that “teeth whitening is a form of dental treatment requiring the application of a chemical bleaching agent directly to the customer’s teeth, the procedure is not without potential adverse effects, such as peroxide burns of the lips and …. Furthermore, tooth discoloration may be caused by an underlying condition or disease, which a non-dentist likely would not detect.” Reasoning that the statute was a reasonable exercise of the Alabama’s legislature’s police powers, the court held that the requirement in the Dental Practice Act that teeth whitening services be performed by licensed dentists did not deny the plaintiffs due process.

Takeaway According to the Institute for Justice, since 2005, at least 14 states have amended statutes or regulations to exclude all but licensed dentists, hygienists or dental assistants from offering tooth- whitening services. In addition, at least 30 state dental boards have ordered tooth-whitening

4 The Board is responsible for enforcing the state’s Dental Practice Act. By statute, the Board consists of six dentists and one dental hygienist.

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businesses to cease and desist, while nine states have brought legal actions against such businesses. Litigation continues to emanate from legislative activity related to tooth-whitening services. For example, in North Carolina Board of Dental Examiners v. Federal Trade Commission, the U.S. Supreme Court found the North Carolina Board of Dental Examiners violated federal antitrust laws by issuing cease-and-desist letters to non-dentists who provided tooth-whitening services in North Carolina. But in that instance, North Carolina’s legislature did not expressly define tooth-whitening services as the practice of dentistry.

U.S. Court of Appeals for the Second Circuit Rules on Tooth Whitening by Non-Dentists

On July 17, the U.S. Court of Appeals for the Second Circuit ruled in Sensational Smiles, LLC, d/b/a Smile Bright et al v. Dr. Jewel Mullen, Commissioner of Public Health and Members of the Connecticut State Dental Commission (case). The court found that the Connecticut State Dental Commission (Commission) is permitted to limit the use of tooth-whitening LED lights to licensed dentists.

Background Sensational Smiles provides tooth-whitening services that involve shining a low-powered LED light into a customer’s mouth for 20 minutes. The Commission issued a declaratory ruling restricting the use of tooth-whitening LED lights to licensed dentists.5 Sensational Smiles challenged that ruling, arguing that the ruling violates the Equal Protection Clause and Due Process Clause of the U.S. Constitution because it lacks a rational basis. The District Court rejected Sensational Smiles’ arguments and granted the defendants’ motion for summary judgment. Sensational Smiles appealed.

Court Opinion The court found that “given that at least some evidence exists that LED lights may cause some harm to consumers, and given that there is some relationship (however imperfect) between the Commission’s rule and the harm it seeks to prevent,” the rule does not violate either due process or equal protection.

Sensational Smiles also argued that the Commission’s rule was purely economic protectionism. Meaning, the true purpose of the Commission’s restriction was to protect the monopoly on dental services enjoyed by licensed dentists in the state. However, the court disagreed, finding that state economic favoritism is rational for purposes of the court’s review of state action under the Fourteenth Amendment.

Hawaii Becomes the First State to Raise the Smoking Age to 21

Gov. David Ige (D-HI) signed into law S.B. 1030 on June 19. The new law raises the age at which people can legally purchase, smoke or possess cigarettes and electronic cigarettes in Hawaii.

Although local governments such as New York City have raised the legal smoking age in recent years, when enacted on Jan. 1, 2016, the new law, Act 122, will make Hawaii the first state in the nation to prohibit the sale, purchase, possession or consumption of cigarettes, other tobacco products, and electronic smoking devices (or e-cigarettes) to anyone under age 21.

5 Under Connecticut law, the State Dental Commission is charged with advising and assisting the Commissioner of Public Health in issuing dental regulations.

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As evidence to support this new law, Gov. Ige cites a report from the Institute of Medicine (IOM), which strongly concluded that raising the minimum age of legal access (MLA) to 21 will significantly reduce the number of adolescents and young adults who start smoking. According to the governor, more than two-thirds of Hawaii high school students who smoke and more than half of middle school students who smoke report that they get their cigarettes from social sources such as friends and relatives who give or buy them cigarettes. By raising the MLA to 21 the governor hopes that those who can legally obtain tobacco will be less likely to be in the same social networks as middle and high school students.

Ten States Selected by the National Governors Association to Participate in a Health Policy Academy

In June, the National Governors Association (NGA) announced that 10 states (Alaska, Colorado, Connecticut, Kentucky, Maryland, Michigan, Rhode Island, West Virginia, Wisconsin and Wyoming) will participate in a policy academy designed to assist governors and their senior staff in establishing or enhancing programs that improve outcomes and reduce the cost of health care for people with complex care needs.

The goal of this specific health policy academy is to assist states with strategic planning efforts to develop or advance systems that improve health outcomes and reduce cost of care for people who are the highest users of health care. Often referred to as super-utilizers, these individuals frequently use the emergency room, hospital inpatient services and other high-cost forms of health care delivery to meet their care needs. According to the NGA, although the super-utilizers represent a small segment of the beneficiary population, they account for a large portion of state Medicaid expenditures.

State Policy Update

• California

On June 24, Governor Jerry Brown (D-CA) signed the 2015–16 state budget allocating $40 million in state funding to provide health insurance to all low-income undocumented children under Medi-Cal, the state’s health insurance program for low-income residents that includes Medicaid enrollees.

This coverage extension is fully funded by state dollars because, by law, federal funds cannot be used for that purpose. Coverage is slated to begin on May 1, 2016. According to Families USA, California is the largest state to decide to cover low-income undocumented children, joining New York, Illinois, Massachusetts, Washington and the District of Columbia.

State Regulatory Update

• Maine

The Maine Board of Dental Examiners is now accepting comments on a proposed rule to remove language for a pilot program which allowed Independent Practice Dental Hygienists to process radiographs. The pilot program expired March 13, 2015. The proposed rule removes the pilot program language, the reporting and inspection requirements, the exposure and findings form, and the geographic restrictions. Further the proposed rule retains the protocols established in the prior adoption of the rule with regard to written agreements with a licensed

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dentist and referral protocols. A public hearing is expected to be held on Aug. 14 and the comment deadline is Aug. 24.

• Washington

The Washington State Office of Drinking Water is now accepting comments on a draft rule to revise the level of fluoride in the state’s drinking water. The current rule requires water systems that fluoridate to maintain a concentration within a range of 0.8 to 1.3 milligrams per liter. However, the State Board of Health is revising the current rule based on the U.S. Department of Health and Human Services recommended single level of 0.7 milligrams per liter as optimal for fluoride drinking water in the United States. The comment deadline is Aug. 31.

Reports of Interest

• The National Academy for State Health Policy has issued a brief analyzing adult dental benefits under Medicaid in seven states (California, Colorado, Illinois, Iowa, Massachusetts, Virginia and Washington). The brief found there is growing recognition of the importance of oral health as it relates to overall health—including pregnancy, avoidable emergency room utilization, and chronic conditions such as and heart disease—as well as employability. In addition, engagement by high-level state policymakers to help raise the profile of the issue, as well as increasing adult dental benefits incrementally, seem to be key for states interested in expanding their adult dental benefits under Medicaid.

• The Association of State and Territorial Dental Directors released its 2015 Synopses of State Dental Public Health Programs. The report provides data on the status of the state oral health programs during the 2013–2014 fiscal year. According to the synopses, 8% of all states (and the District of Columbia) offered no adult dental benefit under Medicaid, while 33% offered comprehensive adult dental benefits. Additionally, 29% of all states offered no adult dental benefits under Medicaid to pregnant women, while 39% of all states offered comprehensive benefits.

• The Alliance for Health Reform and the Robert Wood Johnson Foundation developed a telemedicine toolkit. The toolkit provides an overview of policy implications and uses for telemedicine as well as links to relevant reports on the issue and contact information for experts in the field. The toolkit notes that the number of states making telemedicine coverage mandatory for private insurance plans has grown. Coverage was mandatory in five states in 2000, 12 in 2011, and 24 plus the District of Columbia as of May 2015.

• The Center on Budget and Policy Priorities has published a state fact sheet with an interactive map that provides state-by-state data on how Medicaid improves access to health care for millions of families and individuals.

• The Henry J. Kaiser Family Foundation released an issue brief analyzing how state Medicaid expansion decisions have impacted low-income adults in three states (Ohio, Arkansas and Missouri). Ohio adopted the Affordable Care Act Medicaid expansion, Arkansas adopted the “Private Option” and Missouri has yet to expand Medicaid. The brief discussed (1) how many of the study participants faced financial pressures that negatively impacted their health, (2) how many are in good health but have ongoing physical or mental health problems, and (3) after receiving coverage, most established relationships with their health care providers, allowing them to obtain care and prescription drugs when needed.

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• The National Academy for State Health Policy has issued a brief analyzing the impact of state- based marketplaces (SBMs) under the Affordable Care Act. According to the brief, SBMs represent eight of the top 11 states with the greatest percentage of decreases in uninsured populations: Arkansas (a state–federal partnership state), Kentucky, Oregon, Washington, West Virginia (a state–federal partnership state), California, Connecticut, Colorado, Maryland, Montana (a federally facilitated marketplace state) and New Mexico. All 11 states, except for Montana, also expanded Medicaid. In addition, Kentucky reduced its uninsured rate by more than half, from 20% to 10%. Connecticut saw a similar decline, seeing a decrease in its rate from 12% to 6%. Further, Oregon and Washington both experienced nearly 40% declines.

ADEA Advocacy Website: Helping You Stay Abreast of State and Federal Legislation and Policy

The ADEA Advocacy website is a tool to help you access information on issues of importance to academic dentistry and dental and craniofacial research, and facilitate communication with elected officials on issues of importance to you and your institution.

Through the ADEA Advocacy website, we have made it easy for you to communicate with your elected officials so you can have input on legislation, policies and regulations affecting your profession and your institution. By simply entering your ZIP code or address, you will be able to identify your elected officials and correspond with them directly.

In addition to facilitating direct access to your elected officials, the website has many other features, which you will find informative and useful. Now you can:

• Access memoranda on Supreme Court cases affecting dental education. • Navigate an interactive map containing information on legislation in the 50 states, District of Columbia and Puerto Rico (information is updated every two hours). • Review federal grant information with links to the application process.

Additionally, you will find a database of ADEA documents and communications; that is, comment letters to federal agencies on such issues as Gainful Employment and ADEA coalition sign-on letters to Members of Congress on funding for health professions programs and the National Institute of Dental and Craniofacial Research.

When you access the website, you can navigate it by clicking through the drop-down menus at the top of the page. While in the website, please subscribe to ADEA Action Alerts to maximize your ability to send messages to your elected officials. ADEA members will find the resources and information on the advocacy website useful as they advocate on behalf of academic dentistry and dental and craniofacial research. As President John F. Kennedy stated, “One person can make a difference, and everyone should try.”

ADEA AGR Twitter Account

For additional information on issues affecting academic dentistry and dental and craniofacial research in Congress, federal agencies and state legislatures, please follow ADEA Advocacy and Government Relations on Twitter: @ADEAAGR. There is much to tweet about!

ADEA/Sunstar Americas, Inc./Harry W. Bruce, Jr. Legislative Fellowship

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Dental school faculty members or administrators who want to interface with members of Congress on issues of importance to oral health are encouraged to apply for the ADEA/Sunstar Americas, Inc./Harry W. Bruce, Jr. Legislative Fellowship. The selected fellow spends three months in Washington, DC, working on issues and policies that could make a difference in the life of every American. This public policy fellowship coincides with congressional consideration of the federal budget and other legislative and regulatory activities important to dental education and research. The fellow functions as an ADEA Policy Center staff member who works within the ADEA AGR portfolio on ADEA’s specific legislative priorities.

The fellow’s responsibilities may include drafting policy, legislative language, position papers and testimony; educating members of Congress and other decision-makers on matters of importance to dental education; and participating in gatherings of various national coalitions. The fellow receives a taxable stipend of $15,000 to cover travel and expenses for approximately three months (cumulative) in Washington, DC. ADEA is flexible in the arrangement of time away from the fellow’s institution. The fellow’s institution continues to provide salary support for the duration of the experience. Since its inception in 1985, the ADEA/Sunstar Americas, Inc./Harry W. Bruce, Jr. Legislative Fellowship has been generously underwritten by Sunstar Americas, Inc. Interested candidates should apply now.

ADEA/Sunstar Americas, Inc./Jack Bresch Student Legislative Internship

The ADEA/Sunstar Americas, Inc./Jack Bresch Student Legislative Internship is a six-week, stipend-supported internship in the Advocacy and Governmental Relations portfolio of the ADEA Policy Center (ADEA AGR) in Washington, DC. This student legislative internship provides a unique learning experience for predoctoral, allied and advanced dental students, residents and fellows. The internship is designed to encourage students to learn about and eventually—as dental professionals—become involved in the federal legislative process and the formulation of public policy as it relates to academic dentistry. It is open to any predoctoral, allied or advanced dental student, resident or fellow who is interested in learning about and contributing to the formulation of federal public policy with regard to dental education, dental research and the oral health of the nation. Funded through the generous support of Sunstar Americas, Inc., the student intern will be a member of the ADEA AGR staff and will participate in congressional meetings on Capitol Hill, coalition meetings and policy discussions among the ADEA Legislative Advisory Committee (ADEA LAC) and ADEA AGR staff.

An applicant must be a full-time predoctoral, allied or advanced dental student, resident or fellow whose institution is willing to work with the student to identify an appropriate time, consisting of six weeks, during the school year to pursue the internship. For additional information, please email Yvonne Knight, J.D., ADEA Senior Vice President for Advocacy and Governmental Relations, at [email protected]. Interested applicants should apply now, applications can be found here.

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The ADEA Policy Center publishes the ADEA State Update monthly. Its purpose is to keep ADEA members abreast of state issues and events of interest to the academic dental and research communities.

© 2015 American Dental Education Association 655 K Street NW, Suite 800, Washington, DC 20001 Telephone: 202-289-7201, Website: ADEA.org

Yvonne Knight, J.D. ADEA Senior Vice President for Advocacy and Governmental Relations ([email protected])

Jennifer Brown, J.D. ADEA Director of State Relations ([email protected])

Timothy Leeth, C.P.A. ADEA Senior Director for Federal Relations ([email protected])

Evelyn Lucas-Perry, D.D.S., M.P.H. ADEA Director of Public Policy Research ([email protected])

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