Martha M. Dellapenna, RDH, MEd, has experience in a variety of workplace settings—from academia to industry—but her passion remains public health. She is director of the Washington, DC-based Medicaid-Children’s Health Insurance Program (CHIP) State Dental Association (MSDA) Center for Quality, Policy and Financing, whose mission is to develop and promote evidence-based Medicaid/CHIP oral health best practices and policies through innovative collaboration with a broad spectrum of stakeholders. In this role, Dellapenna provides oversight to the projects and activities of each of the five divisions within the center, including policy and financing, best practices, quality and data, research and evaluation, and professional development.
Dellapenna is a former project manager for the Rhode Island Oral Health Access Project, which works to improve the ability of individuals covered by Medicaid in Rhode Island to receive the dental care they need. She joined the Rhode Island Department of Human Services in the Center for Child and Family Health in 2003 through its project management contractor, Xerox. At the time, her primary role was to develop and manage RIte Smiles, the state’s first managed care dental program for young children. Dellapenna is also the chair of the Centers for Medicare and Medicaid Services Oral Health Technical Advisory Group.
What do you see as the most significant obstacle in solving the nation’s access-to-care problem?
The reasons access to dental care in the United States is still a significant problem for low-income populations are complex and multifaceted. When it comes to Medicaid-insured children, dentists have consistently cited three major reasons for their lack of participation in the Medicaid program: low reimbursement rates, patient noncompliance and missed appointments, and burdensome administrative processes. When trying to access professional dental care, patients and caregivers covered under Medicaid often have trouble finding a dentist, scheduling appointments, managing long wait times, and securing transportation. Additionally, a study of front-office personnel in dental practices revealed that their attitudes and beliefs about Medicaid have a negative impact on the ability of caregivers to find dental care for their Medicaid-enrolled children.1
Speculation by consumer advocates, expert panels, and professional groups suggests that additional barriers exist, including prejudice regarding cultural background and public assistance status, patient inability to get time off from work for limited appointment times, and a lack of experience and ineffectiveness in using the dental care system. These barriers result in negative dental experiences and a perceived low prioritization of dental care among patients. That said, I think the most significant obstacle in solving the access-to-care problem is that other pressing health and economic issues compete with dental care—making it a low priority. Until access to dental care becomes a critical health issue and the necessary planning and developmental resources are appropriated, a real and lasting impact cannot be made. As the Patient Protection and Affordable Care Act legislation is implemented, opportunities will abound for policy makers to re-examine the role of dental care within the broader health care delivery system. We’ve already seen success in a number of states that have made tremendous strides in improving access to and utilization of dental services among Medicaid beneficiaries.
Of which of your accomplishments are you most proud?
I consider working on the development and implementation of Rhode Island Medicaid’s RIte Smiles Program—the state’s first managed care dental program—my most significant professional accomplishment. RIte Smiles—an innovation to the traditional system that was created in a budget-neutral environment—improves access to quality, timely, and appropriate dental services for Rhode Island’s most vulnerable children. Those enrolled in RIte Smiles not only obtain increased access to a large number of participating dentists, they also receive more preventive dental services—lowering the dental disease burden and the overall cost per child. The program successfully achieves the CMS’ triple aim: better health, better care, and lower costs.
What are some of the challenges you face as director of the Medicaid State Dental Association Center for Quality, Policy and Financing?
The MSDA’s overarching goal is to support Medicaid and CHIP in their efforts to ensure availability of quality-driven oral health services for Medicaid and CHIP beneficiaries. MSDA is a nonprofit organization that is faced with difficult budgetary decisions affecting the scope and breadth of the services and support we provide to Medicaid and CHIP oral health program administrators. It is a significant challenge to carry out the activities in our strategic plan if the appropriate funding is not available to support these efforts. Medicaid and CHIP are also challenged by rapidly changing administrative systems, and it’s difficult for MSDA to be tuned into each state’s issues and decisions.
What is a typical workday like for you?
I have a home office for my work with MSDA, which means my workday typically includes various forms of virtual communication and meetings. I spend a few hours each day on the MSDA Center for Quality, Policy and Financing’s objectives. I provide oversight to projects and activities within each of five center divisions that focus on improving state Medicaid programs and CHIP.
One of the biggest ongoing projects I oversee is the development of the annual MSDA National Medicaid and CHIP Oral Health Program Profile Survey Questionnaire, the results of which are posted at: msdanationalprofile.org. The profile is a valuable resource comprising rich program data and information obtained directly from all states and the District of Columbia, which may be used to inform and advance Medicaid and CHIP oral health policies nationwide.
- Lam M, Riedy CA, Milgrom P. Improving access for Medicaid-insured children: focus on front-office personnel. J Am Dent Assoc. 1999;130:365–373.