Like all Community Action Agencies nationally, the Southwestern Wisconsin Community Action Program (SWCAP) conducts a Community Needs Assessment every three years. The first survey that was completed in my time at SWCAP was in 2001 followed by additional surveys in 2004, 2007, and 2010. The survey is designed to ascertain the most pressing needs of low income persons in the five county southwestern corner of Wisconsin served by SWCAP and includes the counties of Grant, Green, Iowa, Lafayette and Richland.
While I was involved in all of the surveys I do have to admit I was surprised by what I found to be the number one problem in the first three and the problem that was within the five most pressing problems in the fourth survey. I had expected to find that the most difficult problems our clients and others who were struggling with low incomes had would be lack of a well-paying jobs, lack of decent, affordable housing, lack of public transportation and difficulty in accessing health care for those without insurance, the means to pay privately, etc. I was certainly correct in the results that reinforced my expectation that the top problems were as I thought, but I had not expected a high priority problem that showed up consistently in each survey: the fact most of our clients and others who were low-income could not obtain dental care.
The reasons that cause the problem of access to dental care are multiple and complex. They include the dwindling number of dentists in rural areas overall, a high no-show rate among patients who have limited ability to pay and the fact many patients have not received dental care for many years (if ever) and, as a result, have very serious oral health problems that require extensive and expensive treatment that is unaffordable. However, the major reason has to do with reimbursement; that is, low-income persons in our area had no dental insurance or had no ability to pay privately or were insured in the Wisconsin Medicaid program. Although many were enrolled in the Wisconsin Medicaid program the reimbursement provided to dentists by Medicaid was so low (and still is) that very few dentists were willing to take on any and usually no Medicaid patients. Many of the dentists I spoke to said it costs them more to provide the care than what they received by Medicaid reimbursement.
After seeing the results of the first survey (around 2004) I was able at that time to look at Wisconsin health data on the Medicaid population and found that in our SWCAP five-county service area around 24,000 persons enrolled in Medicaid had not seen a dentist in the past year and most for much longer than that, if ever. It was impossible to guess at how many non-Medicaid low-income persons had also not seen a dentist but clearly the number in need actually exceeded the 24,000. The problem showing up in our community needs assessments was a real one. So, based on our commitment to our SWCAP mission and being responsive to our community needs, I knew we had to act to remedy this problem as much as possible.
SWCAP was never going to be a provider of dental care. We lacked the expertise, the resources and, even if we tried we would not be able to sustain our own services financially (short of a major benefactor, which I thought unlikely). So I looked for other options and that is when I discovered Federally Qualified Health Centers (FQHC’s). The origins of FQHC’s are the same as Community Action
Agencies (CAAs) in that they started with the War on Poverty in the mid-sixties. They are designed to provide a range of outpatient health care services to low-income persons and many receive grant funding and donations to sustain themselves. Of crucial importance is that they receive cost-based reimbursement for Medicaid recipients, which means their Medicaid reimbursement covers the costs of providing care to Medicaid enrolled patients.
Important to the subject at hand, FQHCs provide dental care and, in fact, in many cases their dental clinics are the largest of their services. However, it is often difficult for them to find the resources necessary to build and equip clinics; although they can operate them on a break even basis, even for the Medicaid population. Given these facts, SWCAP started on a strategy of identifying FQHC partners who would be willing to provide dental care if SWCAP took on the burden of building and equipping dental clinics.
Since 2004, SWCAP has built and equipped two eight-chair dental clinics in our service area; one located in Darlington in Lafayette County and the other in Dodgeville in Iowa County. The clinic in Darlington is operated by Community Health Services, the parent organization of the FQHC located in Beloit. The clinic located in Dodgeville is operated by Access Community Health Centers, located in Madison. Both FQHC’s pay SWCAP rent that we use to pay down the mortgage on the buildings. Each clinic covers their other costs, such as utilities, insurance, etc. SWCAP also received $500,000 grants for each building from the Wisconsin Division of Health, Oral Health Programs. These grants helped pay for building and equipment costs, which totaled approximately $1.5 million to $1.8 million for each clinic. Both have been in operation for a few years and both have been very successful.
In addition to the FQHC clinics, SWCAP also assisted a non-profit group to form and operate a free dental clinic exclusively for low-income children in Monroe, serving Green County residents. Using free medical clinics as a model, this operation uses volunteer dentists and other volunteer staff at a single chair clinic located at a building in Monroe. The Fowler Memorial Free Dental Clinic is sustained financially by some Medicaid reimbursement but primarily by local fund-raising and donations. It, too, has also been very successful and the plans are to expand the facility and services as local funding permits.
The results of the three clinics in Southwestern Wisconsin for 2012 are as follows:
Fowler (Monroe): 608-328-9508
Total of all three clinics
Since its inception, the SWCAP strategy to improve dental access for low-income persons has resulted in 12,060 dental encounters in only one year (2012). We anticipate subsequent years to show a greater increase. This was clearly the result of the community speaking through its needs assessment and SWCAP listening by using its resources and network to, if not completely solve, at least lessen this significant public health problem in the southwestern corner of Wisconsin.
Please feel free to contact me at firstname.lastname@example.org with any comments or questions on this or other offerings of SWCAP.