Michigan Finalizes Rules Expanding Access to Dental Care

Michigan state regulators recently finalized rules that will help expand dental care to the state’s most underserved people, including low-income children and communities of color as well as those who are pregnant, over 65, or in rural areas.

The new regulations, which went into effect in April, officially allow dental therapists to obtain licenses and begin to practice. Similar to physician assistants in medicine, these midlevel providers are trained in preventive and routine restorative services such as filling cavities and extracting badly diseased teeth.

Millions of Michiganders struggle to access regular dental care. More than 1.7 million residents of the state live in areas with dentist shortages. And the Centers for Medicare & Medicaid Services reports that 58% of Michigan children on Medicaid—more than 630,000 kids—did not see a dentist in 2019.

“Dental therapists offer dental clinics a cost-effective way to provide safe and high-quality care to underserved patients,” said Misty Davis, a registered dental hygienist and oral health specialist with the Michigan Primary Care Association, which represents 44 community health centers across the state. “They will be instrumental in helping federally qualified health centers accept more patients who are on Medicaid or who are uninsured.”

The rules implement a 2018 law that made Michigan the eighth state to authorize the practice of dental therapy. Today, 13 states permit the profession in some form. Dental therapists have proved to be highly valuable members of the dental team. For example, in Minnesota, where they have practiced since 2011, these providers help reduce patient wait times and the distances that people must travel to find care, especially in rural areas. They also increase team productivity and improve patient satisfaction. And the cost savings from employing dental therapists allow dental offices and clinics to treat more patients from underserved populations, including those who are publicly insured, without sacrificing revenues.  

The Pew Charitable Trusts provided comments to the Michigan Department of Licensing and Regulatory Affairs on the draft rulesin September 2020. The organization praised the proposed requirements for licensure, practice, and educational standards for dental therapists and expressed strong support for their approval.

With final regulations in place, the state Medicaid agency is taking steps to ensure that dental therapists can enroll in its program and be reimbursed for their services. This administrative action is critical to successful implementation of dental therapy in the state because the law requires that the midlevel practitioners work in settings that primarily serve low-income and other underserved communities.

“Too many people in Michigan are negatively impacted by limited access to dental care,” Davis said. “Expanding the workforce with dental therapists will increase the number of available providers in dental health professional shortage areas, alleviate barriers to care, and ultimately help reduce oral health disparities in the state.”

Kristen Mizzi Angelone is a senior manager and Allison Corr is a research officer with The Pew Charitable Trusts’ dental campaign.