Nearly 12 years ago, a nonprofit organization focused on substance abuse prevention in Lyon County, Nevada, expanded its services to dental care.
Leaders of the Coalition for Healthy Communities were shocked and sprung into action after two of their food pantry volunteers used pliers to pull out their abscessed teeth. The volunteers saw no other way to relieve their excruciating pain in the small town where they lived, 40 miles southeast of Reno, because of a shortage of dental providers.
That drastic act, said Wendy Madsen, the coalition’s executive director, prompted her organization to use mobile clinics to offer health and dental services in rural communities where there aren’t enough patients to support physical offices.
The coalition now sends a van equipped with dental equipment to county schools to treat hundreds of students at a bus stop several times each year. They also organize events providing free care for seniors in the region. The response was overwhelming.
“Dental is the ultimate ticket,” Madsen said. “Everybody wants a dentist. Having these services is what runs out first in these big mobile events.”
The coalition’s mobile programs reflect a nationwide effort to send services to patients experiencing gaps in the health care system, particularly in rural areas.
Rural residents face a greater shortage of health care providers, including dentists, than their counterparts in larger cities. Since the beginning of the pandemic, mobile clinics have increased access to a range of services in hard-to-reach places with sparse populations.
A recently passed law that makes it easier for rural communities to pay for new mobile clinics could expand this trend. In the past, clinics that serve low-income rural residents couldn’t spend money from federal grants — called New Access Point grants — for mobile services in communities where they didn’t already have facilities.
Then, last fall, Congress passed the MOBILE HEALTHCARE Act, sponsored by Sens. Jackie Rosen, D-Nev., and Susan Collins, R-Maine, which gives federally qualified health centers — health clinics serving medically underserved areas — more great flexibility to use federal funding to establish and operate mobile units.
As of 2019, the number of mobile clinics on the road has expanded, according to the National Association of Community Health Centers. Many of these have been used for testing and vaccinations for COVID-19. And health and community organizations have begun using mobile units to provide primary care, behavioral health and reproductive services to off-road patients. The new funding route could soon put even more mobile health vans on the road.
For now, the law depends on funding from Congress, and experts predict it could be at least a year before health centers can access the grant money.
Freed from the physical requirements, health centers can run the vans
Once funded, the regulatory change will allow health centers to partner with independent organizations like the Madsen Nevada Coalition of Medical Communities to expand services in underserved regions. Because the coalition is not a federally qualified health center, it relies on a combination of other federal and state grants.
Nearly 1,400 federally qualified health centers across the country receive federal funding to provide comprehensive health services in underserved areas. The previous requirement that health centers set up physical clinics before expanding mobile clinics prevented many from applying, said Steve Messinger, policy director for the Nevada Primary Care Association. This was burdensome and expensive for health centers.
But in rural areas with small populations well served by mobile clinics, it wouldn’t make sense to set up a building with a full-time provider first, he said. This can eat into the budget of a federally qualified health center.
While the health center advocates lobbying Congress for core funding, the Coalition for Healthy Communities is moving forward with three dental events this year, funded by a grant from the Health Resources and Services Administration, part of the Department of Health and Human Services.
At the first medical event organized by the coalition in 2012 in Lyon County, where 61,400 residents are spread over more than 2,000 square miles, more than 200 people showed up to receive free care and 150 teeth were extracted, Madsen said. Since then, the organization has hosted several events a year — except for 2020, when the pandemic halted operations.
Many of the dental events are school-oriented and provide children with services such as screenings, x-rays, fillings, varnishes and cleanings. But a huge need for care also exists among the area’s seniors, Madsen said, because Nevada’s Medicare and Medicaid do not include comprehensive dental coverage for adults. It’s harder to fund those events, she said.
Of the five communities in Lyon County, at least one, Silver Springs, does not have a single dentist. There are a total of 10 dentists in Fernley and Dayton, communities with a combined population of 38,600, but only two of those practices accept Medicaid, which covers low-income people under 21 and limited dental services for adults.
Meeting a desperate need for dental and healthcare services
Tracy Rothman, who runs the coalition’s food pantries, said the dental outreach events have made a difference for her 29-year-old son, who moved to Silver Springs last year. He went to two mobile clinics to get free care, which Rothman said was a big relief because he was uninsured and needed dental care.
“Otherwise, you’re going to go to someone you pay cash to,” she said. “I often can’t pay, frankly; it’s just out of reach for some people or most people … in rural areas.”
Madsen said the coalition stepped in to help a young student who was in desperate need of a root canal. The coalition helps the girl’s family apply for Medicaid or Nevada Check Up, the state’s health insurance program for children, and pays $1,600 to cover the service with federal grant money. Another student had to be referred to several specialists before having his decayed baby teeth surgically removed and receiving restorative treatment for adult teeth that had begun to decay.
“Her mom was so grateful she was in tears,” Madsen said. “She told me her daughter woke up without instant pain for the first time in years.”
Madsen said her organization has enough grant funding for three events through May, but hopes the MOBILE HEALTH Act will help expand services. In addition to dental care, the group provides mobile primary care clinics for immigrant workers in Yerington, a small farming town about 70 miles southeast of Reno.
Sarah Rich, CEO of Choptank Community Health in Maryland, said she shares Madsen’s hope.
Choptank serves five counties in Maryland, including small towns between the Chesapeake Bay and the Delmarva Peninsula. Amid the pandemic, the health organization struck an unexpected partnership with a car dealership and used federal COVID aid funds to purchase a Ford Transit cargo van for mobile clinics.
Choptank used its new van to provide vaccines, but has since started using it to provide primary care to immigrant workers and dental services to children in 36 schools. The mobile clinics have been so successful that the health center is working on purchasing more vans to expand its services.
Rich said the mobile clinics are “breaking down the barriers that many of us have been working on for a long time.”
Among the new services Choptank is looking to provide are behavioral health, substance use disorder prevention and treatment, and skin screenings for people working on Maryland’s shores.
“Flexibility has been a theme for the past few years,” Rich said. “I think this MOBILE Health Act will help us do that even more in the future.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of three major operational programs in the KFF (Kaiser Family Foundation). KFF is a charitable, non-profit organization providing information on health issues to the nation.