Tribal dental program gets Medicaid funding

OLYMPIA — A federal appeals court reversed a last-minute Trump Administration decision to deny Medicaid funding for dental health aide therapists in Washington tribal communities, Attorney General Bob Ferguson, the Swinomish Indian Tribal Community and the Washington Health Care Authority announced Jan. 19.

These dental aides help fill a void in tribal communities, which have a significant shortage of dentists and dental services.

The state and Swinomish jointly filed an appeal with the U.S. Court of Appeals for the Ninth Circuit after President Biden took office. The state and Tribe also asked the Biden Administration to reverse the decision, but it defended the decision. Last week, the Ninth Circuit ordered the Centers for Medicare & Medicaid Services to approve Medicaid funding for the dental therapists.

The decision to deny Medicaid funding, made by CMS, came on the last day of the Trump Administration and nearly a year after an independent federal hearings officer recommended the funding be approved. CMS had approved Medicaid funding for a similar Alaskan program under the George W. Bush administration.

Ferguson, on behalf of the Health Care Authority and the Swinomish Tribe, jointly filed their petition with the Ninth Circuit in March 2021, asking the court to overturn the federal agency’s decision.

On Jan. 12, a three-judge panel with the Ninth Circuit agreed with the state and Swinomish that CMS’ denial was “not in accordance with law.” The court ordered CMS to approve the Medicaid funding for DHATs in Washington.

Once approved, the federal government will cover the entire cost of DHAT services for Medicaid patients in Washington. Currently, the state is covering all of the Medicaid costs out of its own budget.

In 2015, Swinomish became the first tribe in the country to establish its own dental health provider licensing law and regulatory system, which includes the licensing and regulation of dental therapists.

“We are very thankful for the decision of the Ninth Circuit Court of Appeals authorizing Federal Medicaid payments to Dental therapists working in tribal dental programs,” said Steve Edwards, chairman of the Swinomish Indian Tribal Community. “Dental therapists are a Native solution to the unmet oral healthcare needs in Native communities. They provide culturally appropriate care to the patients and communities they serve and they free up dentists’ time for the most complex conditions and procedures. But in order for dental therapists to be a sustainable part of tribal oral health programs, it is essential that Federal Medicaid payments be available for Dental Therapist services.”

Dental Health Aide Therapist program

DHATs are professionally trained to perform about 40 oral health care and dental procedures in a culturally competent manner, ranging from preventative services like cleanings to simple extractions.

Washington’s DHAT program was modeled after the successful program in Alaska, which is widely used in tribal communities there.

After Swinomish created its own dental licensing program, the first tribal dental therapist outside Alaska began practicing at the Swinomish Dental Clinic in 2016. Swinomish subsequently sent several tribal members to Alaska to be trained and has since developed a training program with Skagit Valley College which is more accessible to students in the lower 48 states.

CMS approved Medicaid funding for Alaska’s DHAT program, which began in 2004.

Medicaid funding fight

The federal Indian Health Care Improvement Act, reauthorized as part of the 2010 Affordable Care Act, specifically referenced that DHAT services could be included under the federal Indian Health Service. Once HCA’s request was approved, the federal government would pay 100 percent of Medicaid costs in tribal health programs.

CMS denied the request in May of 2018. HCA and the Swinomish Tribe asked the federal agency to reconsider its decision. A federal hearings officer in February 2020 agreed that Medicaid funding could be used and recommended approval.

The administrator of CMS disagreed and denied the use of Medicaid funds in Washington on the last day of the Trump Administration.

The ruling by the Ninth Circuit reverses that decision.

Source: Attorney General’s Office